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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M2019049 <br /> Washington County Receipt#: 29329 <br /> Jason Lockard Date: 09/17/2019 <br /> 501 E 4th Ave <br /> Permit: M2019049 <br /> Otis CO 807430000 <br /> MethodPayment Revenue Code Fee Description/Notes Amount <br /> Check#92351 4300-MAPP Minerals Application Fees $1,258.00 <br /> User: sdt <br /> Receipt Total: $1,258.00 <br /> Page 1 of 1 <br />