2017-02-24_REPORT - M1975009

• Permit No: M1975009
• IBM Index Class Name: Report
• Doc Date: 2/24/2017
• Doc Name: Annual Fee/Report/Map
• From: The Lakewood Brick and Tile Company
• To: DRMS
• Annual Report Year: 2015
• Email Name: MAC
• Media Type: D
• Archive: No

COLORADO
Division of Reclamation,
Mining and Safety
Department of Natural Resources
1313 Sherman St. Room 215
Denver, CO 80203
August 1, 2015
Thomas J. Murray
The Lakewood Brick and Tile Company
1325 Jay St
Lakewood, CO 80214
Doughty's Pit, Permit M-1975-009, Annual Fee Invoice and Report Request
PLEASE READ CAREFULLY — ACTION REQUIRED
Please attach your COMPLETED written Annual Report and Annual Report Map to this form
Under the terms of your Reclamation Permit and Colorado Statutes, you must submit an Annual Fee and Annual
Report (including a map). You must pay the Annual Fee and submit an Annual Report each year until reclamation
responsibility release is granted. The Annual Fee is not a renewal fee. The Fee and Report are for LAST YEAR'S
mining and reclamation season, and MUST be paid even if your operation was inactive.
The Annual Report and Fee requirement will be considered submitted when we have received the following
components:
1. APPROPRIATE ANNUAL FEE
2. COMPLETED ANNUAL REPORT
3. ASSOCIATED MAP as required by rule
If you have requested reclamation responsibility release from the Division of Reclamation, Mining and Safety
("Division") but your permit is not released by the anniversary date listed below, the Annual Fee MUST be paid. If
the permit is released before the anniversary date, then by Statute, it is not necessary to pay an Annual Fee or submit
an Annual Report for that year.
Division records indicate the $323.00 fee is due for the following:
Permit: M-1975-009
Operation Name: Doughty's Pit
Anniversary Date: September 30, 2015
Total Fee Due: $323.00 (Due on or before your Anniversary Date)
Return the enclosed Annual Report FORM, a MAP, and a CHECK or MONEY ORDER made payable to: Division
of Reclamation, Mining and Safety, 1313 Sherman St., Room 215, Denver, CO 80203. If your records indicate
these documents and fees have already been submitted, please notify the Division.
OF CO4
LC �'
1313 Sherman St. Room 215 Denver, CO 80203 P [phone] F * *;
John W. Hickentooper, Governor I Mike King, Executive Director I Virginia Brannon, Director.