2017-08-30_REPORT - M1993035

• Permit No: M1993035
• IBM Index Class Name: Report
• Doc Date: 8/30/2017
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Summit County Government and Town of Breckenridge
• Annual Report Year: 2017
• Media Type: D
• Archive: No

Page 5 of 5

Division records indicate the following permittee/landowner contact information (blank fields indicate that we do not have
information on record). If this information is blank or not current , please type or print current contact information:
Permittee Contact:

Brian Lorch
Permittee Company:

Summit County Government and
Town of Breckenridge

Address:

P.O. Box 5660
Frisco, CO 80443

Phone Number:

[phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact:

Heide Andersen
Company:

Town of Breckenridge
Address:

P.O. Box 168
Breckenridge, CO 80424

Phone Number:

[phone]
Fax Number:
Email Address:
Inspection Contact:

Brian Lorch
Company:

Summit County Government
Address:

P.O. Box 5660
Frisco, CO 80443

Phone Number:

[phone]
Fax Number:
Email Address:

I, the undersigned, hereby state that the information provided in this report is true and accurate, and that site operations are
being conducted in accordance with the Division approved mining and reclamation plans.

Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date

M-AF-04