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3/7/22, 10:28 AM Annual Report ePermitting Signup-Google Forms <br /> Please complete this form to create a new ePermitting account for submittal of annual <br /> reports and fees. You will receive an email with your login information within two business <br /> days. This form is for new ePermitting account activation. If you have already enrolled in <br /> ePermitting, you should not complete this form. <br /> Name of Permittee or NOI Holder: <br /> Heartland Aggregate Mining <br /> Street Address: <br /> 1215 Platte Dr <br /> ................................................................................................................................................................................ <br /> City: * <br /> Fairplay <br /> State: <br /> Colorado <br /> ................................................................................................................................................................................ <br /> Zip: * <br /> 81623- <br /> Telephone: <br /> 9703190076 <br /> ................................................................................................................................................................................ <br /> https://docs.google.com/forms/d/1 lrxOW3YTBhUgGtgfeXDsK5GkvVjw_jFE-9jmiKZURFs/edit#response=ACYDBNhidGitEygFDOfgp6Agtd_IDfkeciJ 1 iP... 2/4 <br />