2005-11-04_REPORT - M1981154

• Permit No: M1981154
• IBM Index Class Name: Report
• Doc Date: 11/4/2005
• Doc Name: Annual Fee/Report/Map
• From: San Miguel County
• To: DMG
• Media Type: D
• Archive: No

,.
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
~~Y~P~~
u/A~
ANNTIAT, FF.F. and RF,PORT RF.(?iTFCT RECEIVE[
,,~j~ ~OV 0.41005
Y' San Miguel County ~f
// /~ Division of Minerals ana Gealog~
1/Ii~I-1981-154
Norwood Pit
November 20, 2005
$688.00 (Due on or before your anniversary date)
San Miguel

-Accordingrto-G,R.S: 34-32.5-1-16.or-G:R:S.-34-32-116,_each-year,-on-the-anniversary-date=of-the-permiE; as----.
operator-shall-submit-the annual-fee,-a roport-and-map showing-the-extent-of currznt'disturbanczs-to'affected --
land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to
occur during theupcoming yeaz, reclamation that will be performed during the coming year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
adequately
report.
Division re
changes:
Permittee
Permittee T
Address:
Phone Number:
Fax Number:
If you have
below or a
enclosed.
revised written annual re~nrt and anmral report malt to this form- please note that an
map that clearly delineates and includes the above elements may suffice for a written
indicate the following permittee contact information. Please verify and make any necessary
Mike Horner
San Miguel County
P.O. Box 426
Norwood, CO 81423
[phone]
[phone]
Tonal comments and/or information that should be provided to the Division, please provide it
it to this form along with your written report and map. Annual Report instructions are
Officer, Owner, or llesignee

Date
M:~PERMITMASTERD000M ENTSUI-AF-09