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" • IIIIIIIIIIIIIIII III <br /> 999 <br /> ' RECEIVED <br /> ANNUAL FEE and REPORT REQUEST MAY C' 2 2001 <br /> PERMITTEE NAME: Lincoln County Division of Minerals and Geology <br /> PERMIT NO.: M-1978-079 <br /> OPERATION NAME: Daugherty Pit <br /> ANNIVERSARY DATE: May 24,2001 <br /> ANNUAL FEE DUE: $225.00(Due on or before your anniversary date) <br /> COUNTY: Lincoln <br /> According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br /> operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br /> land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br /> occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br /> beginning of active operations, and the date active operations ceased for the year, if any. <br /> Please attach your revised written annual resort and annual report man to this form. Please note that an <br /> adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br /> report. <br /> Division records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: <br /> Permittee Contact: -Pete-Ategmr• �pr( QC.Q /CP <br /> Permittee Name: Lincoln County <br /> Address: P.O. Box 39 <br /> Hugo, CO 80821 <br /> Phone Number: (719) 743-2337 <br /> Fax Number: `7 1fj- 7 �?8/S <br /> If you have additional comments and/or information that should be provided to the Division, please provide it <br /> below or attach it to this form along with your written report and map. Annual Report instructions are <br /> enclosed. <br /> Signature of Corporate Officer or Owner <br /> ©g/zo �o <br /> Date <br /> M:TFRM1TMASTERD000d1ENFS -AF-04 <br />