Laserfiche WebLink
~II ~IIII~II~~~~~ ~I~ <br />999 <br />OF CO! <br />~~ O~9 <br />~~ 4`~~1~ ~ DEPARTMENT OF NATURAL RESOURCES <br />• ~ ¢~o ~ *O ~ Dand H. Getches. Executive Director <br />'~''y' MINED LAND RECLAMATION DI\ <br />• X876 + DAVID C. SH ELTO N, Director <br />Richard D. Lamm <br />Governor APPLICATION FORM FOR A REVISION <br />TO A COAL MI NI N6 AND RECLAMATION PERMIT <br />This form must be completed and submitted with all requests for minor revisions, as <br />defined in Rule 1.04(73), technical revisions as defined in Pule 1.04(36) and permit <br />revisions, as defined in Rule 1.04(90). All revisions are to address the requirements <br />of Rule 2.08.4. <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 <br />being revised. The revision date should be printed in the lower right corner of the <br />revision pages. If necessary, the Table of Contents should also be revised. <br />Date: o7/1y/~~ <br />Permittee:-r/, 2.- ~ o c ,~ c ~ S~~ ~- Co . <br />Street: 9 7 f- c.i~ ~~ ~- G a ~~ T <br />- - - - - - - - - - - - - - - <br />City: G~ L12 ~.~ ------------- <br />State: C o Zip Code: ~~? ~ o L - ---- <br />Permit No.: C - ~/ - o,j S <br />This box to be filled in by the Division: <br />Type of Revision: ~~ (PR, TR, or MR) <br />Revision Number Q ~ (Sequential by Revision Type) <br />Revision Submittal Date 7 /// /~ (Date Received by Division) <br />Pevision Completeness Date Z/~/~:y Revision Incompleteness Date - <br />Revi si on Adequacy Due Date _/_/_ Revision Adequacy Date _/_/_ <br />Revision Decision Due Date 9 /~ Fee 50.00 <br />Brief Description of Revision: ~ ~ f~ ,Q o ~ o ~~ - /1L o .v /%a,~a~.,va- <br /> ~ ~ o ~ ~Ti o./ <br />- - - - - - - - - - - - - <br />- - - - <br />Public Notice Attached - Yes _ No (Required for PR's and TR's) <br />Bond Increase: Yes _ No ~c <br />Proposed Change in: <br />Disturbed Area (+/-) _ _-_ _ Acres Affected Area (+/-) _ _ -_ _ Acres <br />Permit Area (+/-) _ _-_ _ Acres Federal Land (+/-) _ _ -_ Acres <br />State Land (+/-) - Acres Private Land (+/-) - Acres <br />Lead Reclamation Specialist ~'~,d 6185E <br />423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203 Tel. (303) 866-3567 <br />