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<br />of cO~o <br />~~ <br />~~ ~~ $ <br />N <br />r ''~ ~ <br />•~i <br />~ /876 <br /> <br />DEPARTMENT OF NATURAL RESOURCES <br />D~rie H. Getcnes. E.ecutne Director <br />MINED LAND RECLAMATION DIVISION <br />DAVID C. SMELTON, Dirst:tor - <br />nlcn~re D. U~ <br />DO`c'"Or APPLICATION FORM FORA REVISION <br />TO A COAL MINING AHD RECLAMATION PERMIT <br />This fora must De 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.D4(90). A11 revisions are to address the requirements <br />of Rule 2.08.4. <br />A71 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: .~~/ .~21-/ ~n <br />Perini ttee: T R A P P E R- M ~ t~ L~~- <br />1.1L~----^------- <br />Street: ~.9..-~__0._..X-1...a~----- <br />SUP! .. <br />City: -~--gg~--~------------ ..,~.~:_~!.t,.~ <br />State: ~ ~ Zip Code: ~ 1 ~ ~ ~ - - - - - <br />Permit No.: C - $ 1 - ~ 1 ~ <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 _/_/ (Date Received by Division) <br />Pevision Completeness Date -/ / Revision Incompleteness Date -/ / <br />Revision Adequacy Due Date -/ / Revision Adequacy Date -/ / <br />P.evision Decision Due Date / / Fee SO.OD <br />Brief Description of Revision: ~~.~J~,~~~~-~~p~-SIB-~ 0 N <br />~~~.C_I._Il_E~~'-B~.._P~.~.~.~-11~E N T <br />Public Notice Attached - Yes _ h'o X (Required for PR's and TR's) <br />Bond Increase: Yes _ Ito _~ <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 A s 6185F <br />423 Centennial Building, 1313 Sherman Street Denver, Co lorado 80203 Tel. (303) 866-3567 <br />~IIII~~I~~I~~~~~~~~ <br />