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IN1 ~~' <br />/ ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: / Fremont County ~a ~ ~E r ~ ~ "~ <br />PERMIT NO.: / M-1986-010 ~ SAN ~ ~ • , , ~ <br />OPERATION NAME: Cottonwood Pit Division o~Rec. <br /> . <br />°n, <br />Mining and Saf <br />ANNIVERSARY DATE: January 20, 2007 ety <br />ANNUAL FEE DUE: $$688.00 (Due on or before your anniversary date) <br />COUNTY: Fremont <br />yyru~ =,•t <br />~~, i 7" <br />--According-to-C-.R:S:-34-32:5-1-16-or-C:R:S--3Y=32=I16,-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 report and annual repots map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred durinti the previous vear and no <br />new chanties to the previous year's map are necessary, they no new map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Curtis Stone <br />Permittee Name: Fremont County <br />Address: Fremont County Commissioners <br />615 Macon Ave., Room # 105 <br />Canon CIty, CO 81212 <br />Phone Number: (719) 276-7320 <br />Fax Number: (719) 275-7626 <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 aze <br />enclosed. <br />Signatur~Off~er, or Designee <br />~~7 <br />Date <br />M:~PERD971MASTERDOCUIvffNr'$4M-AFA4 <br />