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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Saguache County <br />M-1977.567 <br />Airport Pit <br />November 25, 2002 <br />$281.00 (Due on or before your anniversary date) <br />Saguache <br />RECEIVED <br />NOV 2 7 2002 <br />Oiuisien at Minerals and Geology <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 />ta`n ,red c7amation accompii'she to ate an urmg t e preceding year, new disturbances that are anticipated to <br />occur during [he 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 vour revised written annual report and annual report mau to this form. Please note that an <br />adequately labeled map that clearly delineates and urcludes the above elements may suffice for a written <br />report. <br />Division records indicate the following permit[ee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: John T. Ungefug <br />Permittee Name: Saguache County <br />Address: P.O. Box 476 <br />Saguache, CO 81149 <br />Phone Number: (7 ] 9) 65~-2554 <br />Fax Number: (719) 655-2543 <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 />Signat of Corporate Offic ne or Designee <br />~~ Izz T~~ <br />Dale <br />M iPERM ITNIASTERDOCUMENTSU7-AF-Q1 <br />