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ANNU~FEE and ~P~R' REQUEST <br />PERMITTEE NAME: /Grand County Department of Road and Bridge ~ ~"; tom, ± r ~ ~~~ D <br />PERMIT NO.: <-M-2006-029 /~ (` q 7 <br />ifiU^ a `- LQ~! <br />OPERATION NAME: South Fork Gravel Pit (aka Williams Fork) <br />ANNIVERSARY DATE: Au ust 28 2007 Division of ;tec!amation, <br />g ~ Ulining and Safety <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Grand <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 to affected land, <br />- -aeclamation-accomplished-to-date_and_during the preceding year, new disturbances_that aze anticipated 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 vour revised written annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee. resort. and associated <br />map. If no new disturbances or reclamation have occurred during the previous veer and no new chanties to <br />the previous year's map are necessary. then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: Bill Clark <br />Permittee Name: Grand County Deparhnent of Road and Bridge <br />Address: P.O. Box 9 <br />Phone Number: <br />Fax Number: <br />Granby, CO 80446 <br />(970)887-2323 <br />(970)887-3168 <br />If you have additional comments and/or infom~ation 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 enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />