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<br />~~ <br />PERMITTEE NAME: Sheldon Gosney <br />PERMIT NO.: M-1977-446 ; •~.'i 2 r~ ^C~~ <br />OPERATION NAME: Ignacio Pit ni^iaie~ oi' i~sr ::° r' ~''~i'~•~ <br />ANNNERSARY DATE: December 30, 2004 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: La Plata <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances t_o affected land_ <br />- - °reclamation-aceomplishedis date and-during the preceding year ew dis-tu ances that are-a-tn icipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual rennrt and annual rennrt man to this form. Please note that an <br />adequately labeled map that clearly 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: <br />Permittee Name <br />Sheldon Gosney <br />Sheldon Gosney <br />Address: <br />Phone Number: <br />Fax Number: <br />P.O. Box 1186 <br />Bayfield, CO 81122 <br />(970) 884-4684 <br />(970)563-4299 <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 enclosed. <br />/ ~Clsr, s~r~- <br />Signature of Corpo Officer, Owner, or Designee <br />i~.~ ~~~a~~y <br />Date ~~ --T <br />