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-- -- ~ ~-~~ ~~ III IIIIIIIIIIIIIIII <br />S ~~ pF,'gq( <br />~e <br />,. <br />• .1 i <br />• 4 <br />•r ? , <br />Nk1urE D. Lamm <br />Oowmor <br />DEPARTMENT OF NATURAL RESOUi1CES <br />O~+rk K 6nenr.~. E~~eurM o~reewr <br />MINED LAND RECLAMATION DI1 <br />DAVID C.BHHITON, Dinoeot <br />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 />- '~ defined in Rule 1.04(73). technical revisions as defined in Rule 1,04(3fi) and permit <br />'~ revisions, as defined in Rule 1.04(90), A11 revlsions~are 1:o address the requirements <br />=-_= of Rule 2.08.4. <br />A11 revisions are to be formatted so they can be inserted into the permit 1:0 replete the <br />rvvised 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 torner of the <br />= revision pages. If necessary. the Tabte of Contents should also be revised. <br />Date : 0 4 J 0 ~/ ,~ ,~ <br />Perini Ltee: C ~ ,•j, ,~ ~ ~ ~ ~ , ~ •g ,~ ~ ~ _, <br />Street:. 2 9 ~ 7 3~B~J111_..._,~_ <br />Q., 1L.lL1.l_~~..A~~21., <br />City: 0 A K C ~,..~.~,~,___.___,•_,_._~._ <br />State: C 0 Zip Code; 8 0 4 6 7- •, ` _, ` <br />Permit No.: C- 8 1- O T I <br />This box to be filled in by the Division: <br />Type of Revision: , _ (PR, TR, or MR) - <br />Revision Number _ ._.. (Sequential by Revision Type) <br />Revision Submittal Date _/ / iDate Received by Division) <br />Revision Completeness Date ,/ /, Revision Incompleteness Date _/ / <br />Revision Adequacy Due Date _/ ! Revision Adequacy Dete `/ / <br />Revision Decision Due Date / / Fee 50,00 <br />Brief D.et:t>•iptian of-Revlsi on: -SLITS INy~,S~ygiij~( NEA-~ J,,,l~ <br /> FACILITY` AT_ TIPPLE 2 ,~ _ _,,, _ ~ _ _._. <br />Public Notice A ttached - Yes ~ No X (Required for PR's and TR's) <br />Bond Increase: Yes No X <br />Proposed Change 1n: <br />Disturbed Area (+/-) __.. ^ _ _ Acres Affected Area (+/-) _ y .,.. ` Acres <br />Permit Area (+/-) ~ ` ~,~ Acres Federal Land (+/_) .__. _ ` Acres <br />State Land (+/-) Acres Private Land (+/-) Acres <br />teed Reclamation Specialist _ _ _ 6185E <br />\ 423 Centennial $uilding, 1313 Sherman Street Denver, Colorado 80203 Tel. (303) 866.3567 <br />