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ri15~ <br />h h~, ~~/~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />l~ANNiiAi. FF.F. and RF.PnRT RF.niTFST <br />/P,ark County <br />M-1980-013 <br />Elkhorn Springs Pit <br />April 1, 2006 <br />$281.00 (Due on or before your anniversary date) <br />Park <br /> <br />v 1~'il{I~ ~ .-' ?_006 <br />t/prv~uon of t/mcral, znd Ceolo;!Y <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, rew disturbances-thatare-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 ym~r revised written annnal report and annnal repo m P to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since 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: R ce /per /~ /1 //l/~L O~ J //1il L//~/~/ t/ <br />Permittee Name: Pazk County <br />Address: P.O. Box 147 <br />Fairplay, CO 80440 / <br />Phone Number: (719)~36~282 ~ ~ ~ ~~ 8 ~ i/ <br />Fax Number: (719) 836-4275 <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 />Signa r of C rporate Oft caner, or Designee <br />~3- /7-06 <br />Date <br />M:IPERMI7VdAS7ERD000M1sNTSNr-AF-04 <br />