REV14653

• Permit No: C1981013
• IBM Index Class Name: Revision
• Doc Date: 12/22/1983
• Doc Name: APPLICATION FORM
• Type & Sequence: TR36
• Media Type: D
• Archive: No

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STATE OF COLORADO
~ `•^ (~ ^,• Roy Romer, Governor
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DEPARTMENT OF NATURAL RESOURCES '~ ~~'
~.-.,
MINED LAYdD RECLAMATION DIVISION '~'~~''
FRED R. BANTA, Olnctor APPLICATION FORH FOR A REVISION __~ ~ ~•
70 A COAL MINING AND RECLAHATION PERMIT ~°
This form must be completed and submltted with all requests for minor revisions, as defined
in Rule 1.04(73), technical revisions as defined in Pule 1,04(36) and permit revisions, as
defined in Rule 1,04 (g0 ). All revisions are to address the requirements of ?ule 2.08.4,
Three copies of your revision including maps must De submitted in order for it to be complete.
All revisions are to De formatted so they can be inserted into the permit to replace the
revised sections, maps, tables and/or figures. Explain in the revision what section is Dein;
revised. The revision date should be printed in the lower right corner of the revision
rages, if necessary, the Table of Contents should also be revised, then the final versicn
of ~he revision is approved, 7 copies must be sent to OS11 in Denver for Federal mines am ~~
non-Federal mines 1 copy must be sent to OSM at 625 Silver Avenue, SW, Suite 310,
;,lbuquerque, New ttexico 87102. The revision may not proceed until OSM.nas been provi;ed
codes. Copies should be sent certified mail.
Date: i' ~_/z z/ S~
Permittee: z'' S / ~' ~'~SC v i~ ~ ~>
,freer: ~_s'~~? ~/f/G1jr- ~v.6' ~ / ~ - - -- - -
Lily: ~ - - .- - - - - - - ._ - - - - - ._
State: ~` ~~ -Zip Code: ~
permit No.: C S~/ - Gt r 3 - - - - - - - - -
.:. ._
t4ine Name: L~ G' L. 7 ~ ,4.,' ~~-G G~- - - - - - -
~ is ox o e a to y e tvtston:
Type of Revision; -~~2 (PR, TR, or MIR )
Revision iiumber: - - (Sequential by Revision Type)
Rev. Submittal Date: _ _/_ /_ _ (Date Received by Division}
Rev. Completeness Date: - -/ -/- - Rev. Incompleteness Oate: - -/- -/- -
Rev. Adequacy Oue Date: - -/- -/- - Rev. Adequacy Oate: - -/- -/- -
Rev, Decision Due Date: - _/ _/- _ Lead Reclamation Specialist: - -
rte escrtp ton o evtston: _ ;~ ~, V ~-~y _` - ~!~_ - - -
`
-
- - -
-'
Public Notice Attached - RR s and
TR s)
Ao (equtre~ ~or
Yes
Bond Increase: Yes
` t!o ~ -Federal ~- Hon-Federai !•line
Proposed Lhange in:
I sturbed Area (+/-) Acres
Acres Affected Area (+/-)
rermit Area (+/-) - - _ _ _ _
- - Acres Federel Land (+/-) Acres
State Land (+/-) - - - Acres
- - Acres Private Land (+/_) -' -
6185F (Rev, 10/88) _
- - -
2 t 5 Centennial Building, 13 t3 Sherman Street Denver, Colorado 80203.2273 Te1.13031 86 63 56 7 i