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<br />•\\\l.:\I. F'1•:1? and RI•:1'l)R f RIC(jl Elf <br />PhR~tl'I-I I'li NAML•: - Park ('ounly `' <br />I'I:R\111 NU.: 1 ~1-19811-U14 1 L . i <br />OI'IiRAIION NA~II!: Fae~cn \lilc I'il , <br />ANNIVERS:\R1' I):\ I If: :\pril I, 2(1(In <br />ANNI;AI hl l: Ul'I•: S68R.00 (Uuc nn or before tour annhenary dsue) <br />('Ol tN'fl': Park <br />Accordntg to ('.R.S. 34-32.>•11G ur ('.R.S. 34-32-I I(i, each year, un the mtmvcrs:vy dote of the permit, an <br />olxrnur shall submit the annual fcr, a relx+rt and map showing the extent of curcent disturbances to ul•tccted <br />land, rc~ I:nnatiun :rccomplishal to .late :aui dunng the preceding year, nc:, disturbances that arc anticipated to <br />occur dwing the upcoming year, reclamauun that wrll be pcrli,rntrd dunng the conung year, the dates ti+r the <br />Ixginning of active operations, and the date active olxrutions ccaseJ tier the year, if:my. <br />1'Ieasertlnch~~nur revised »rinen annual report and annual report ma7r to thie fnnn. Ylcuse uufr flrrlf r1n <br />udr•quurrh I,rhrA•d rrrrrlr drru rlrurh drlim•Irr+tr <rnd rnrlrrdre rhr .rlan\• \lrmrrtL. nrrn ,rrjJirrJnr a nvirfr•n <br />ra•purr. <br />1)nasum records mdreatc the li~llowntg pemtittec contact inlurrrwuon. Plcax verify and make any necessary <br />changes: <br />Pcnnittcc Contact: ance <br />pcnnntcc Namc: Park ('aunty <br />\Jdre~* I',tl. Ru.v 147 <br />Fairplay. ('() 811:7-111 <br />~~~ ~N~ o~ T.yL.~~ <br />1'honc \unthcr: (719) }j}G-~28~ --- B 3 !o ~.Z b~ 3 <br />Pax Number (7191 StG-4275 <br />If you have addnional comrmnts mtd•'or utli+rmalu>n that should he provided to the IAnsron. please provide n <br />Ixlow or attach it to thrs firms along wnh your wnttcn report and map. Annual Report rmtruetiuns arc <br />rnclosed. <br />~ i-ti ~ <br />Signatu o ('o xatc <)11ici:rx IksiNmce <br />-/~~U(~ <br />Date <br />\I 1'1 k\11 L\L\\II iIIM •.~ \II\,C\! \I-~.1 <br />