Laserfiche WebLink
iii iuiuiiiiiiiiii <br />STATE OF COLORADO <br />Roy Romer, Gove <br />DEPARTMENT OF NATURAL RESOURCES <br />MINED LAND RECLAMATION DIVISION <br />FRED R. BANTA, Olr~etor APPLICATION FORM FORA REYI$ION <br />TO A COAL MINING AND RECLAMATION PERMIT <br />This form must be completed and submitted with all requests for minor revisions, as defined <br />in Rule 1.04(73), technical revisions as defined in Rule 1,04(36) and permit revisions, as <br />defined in Rule 1,04(90), A71 revisions are to address the requirements of Rule 2.08.4. <br />Three copies of your revision including maps must be submitted in order for it to be complete. <br />All revisions are to be formatted so they can be inserted into the permit to replace the <br />revised sections, maps, tables and/or figures. Explain in the revision what section is being <br />revised, The revision date should be printed in the lower right corner bf the revision <br />pages. If necessary, the Table of Contents should also be revised, 'Ahen the fi^al version <br />of the revision is approved, 7 copies must be sent to OSM in Denver for Federal mines and for <br />non-Federal mines 1 copy must be sent to OSM at 625 Silver Avenue, SW, Suite 310, <br />Albuquerque, New Mexico 87102. The revision may not proceed aJntil OSM has Deen provided <br />copies. Copies should be sent certified mail. <br />Date: -~/ L D / ~i 3 <br />Pe-mittee: ~ ~} 5 / iU - ,~ ~' S D v Q C' ~5 <br />r•eet: L !~ ~ U c7 - Lf ~ ,( /f Cep /~~' - L,Z ~VEC: <br />- - -------- :r 131993 <br />State: ~c~ Zip Code: ~ 1 ~ll----- ..-... <br />Permit Na.: C - ~ ( - Q ( Z <br />ine Name: ~~' w- ~ / (<- - - - - - - <br />ts ox o e t e 1n y e tvlslon: <br />Type of Revision: - - (PR, TR, or MR) ; <br />Revision }lumber: - - (Sequential by Revision Type) ~ <br />Rev. Submittal Date: _ _/_ _/_ _ (Date Received by Division) <br />Rev, Completeness Date: - -/- -/- - Rev. Incompleteness Date: - -/- -/- - <br />Rev, Adequacy Due Date: - -/ -/- - Rev. Adequacy Date: - -/- -/- - <br />Rev, Decision Due Date: / _/- _ Lead Reclamation Specialist: - , - <br />r1e escrtp ton o ev ston: ~ .M p 1yo ~s~ s sr~ -,~~ - <br />Public Notice Attached - Yes ~ ~Io ~qutr~ ~or~R s and-TR s)- - <br />Bond Increase: Yes IIO '~deral Non-Federal _~ Mine <br />proposed Change in: <br />:;~'sturbed Area (+/-) Acres Affected Area (+/_) Q,- Acres <br />vermit Area (+/-) - - ~.- Acres Federal Land (+/_) - - Acres <br />State Land (+/_) - = 7T - Acres Private Land (+/-) - _ ~ Acres <br />6185E (Rev. 10/88) - e~- - <br />215 Centennial Builtling, 1313 Sherman Street Denver, Colorado 802032273 Tel. (303) 666-3567 <br />