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o <br />. .P <br />- ~`~ 9$ <br />8 <br />b ~ <br />`L•'' <br />' ~a76 <br />DEPARTMENT OF NATURAL RESOURCES <br />Da viO H Getc rtes. Eaecuiive Director <br />MINED LAND RECLAMATION DIVISION <br />DAVID C. SNELTO N, Director <br />c"ato D. Lamm <br />G°"""°' APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PERMIT <br />this form must be completed and submitted with all requests for minor revisions, as <br />fefined in Rule 1.04(73), technical revisions as defined 1n Rule 1.04(36) and permit <br />revisions, as defined in Rule 1.04(90). All revisions are to address the requirements <br />1f Rule 2.08.4, <br />111 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 />eing 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 />)ate : _4.- L/ 12/ ..8 1 <br />Permittee: ~1~~~-~L~JL~~---- <br />~~~~~~~~ <br />~~~1-~~~~~~~--- JUN 151987 <br />itreet: ~Q-~~~-L~~.2---- ~~+tNtULAiVu <br />- - - - - - - - - RECLAMATION DtVtSiON <br />- - - - - - <br />Mate: C Q Zip Code: ~1~2~. ----- <br />Permi t No.: C - 0_41 - ~ L _ <br />This box to be f111ed in by the Division: <br />Type of Revision: ~= g (PR, TR, or MR) <br />Revision Number Q ~ (Sequential by Revision Type) <br />Revision Submittal Date Q(a/15/~ (Date Received by Division) <br />P.evision Completeness DateCl~/a,,/g-) Revision Incompleteness Date -/-/ <br />Revision Adequacy Due Dated/a,/~ Revision Adequacy Date -/ / <br />on Decision <br />Irief Description of Revision: <br />'ublic Notice Attached - Yes X <br />lond Increase: Yes No X <br />No (Required for PR's and TR's) <br />troposed Change in: <br />Itsturbed Area (+/-) _ _ 0 , p Acres <br />permit Area (+/-) _ _ p .0 Acres <br />Mate Land (+/-) _ - Q Acres <br />ead Reclamation Specialist ~ ~ ~ <br />423 Centennial Building, 13 i 3 Sherman <br />l <br />Affected Area (+/-) _ _ 0 .0 Acres <br />Federal Land (+/-) _ _ 0 Acres <br />Private Land (+/-) _ - ~ Acres <br />6185E <br />Street Denver, Colorado 80203 Tel. (303) 866-3567 <br />iii iiiiiiiiiiiii iii <br />999 <br />