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n ~ <br />/I~ ^ Ar v <br />~/r f ~/ 1 <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 />Larimer County t/ <br />v~-1985-135 <br />$orton Gravel Pit <br />January 31, 2007 <br />RECEI <br />>~ p 4 2001 <br />pivlslon of Reclamation, <br />-Jlinm9 and SafeH <br />$$688.00 (Due on or before your anuiversary date) <br />Larimer <br />According to C.R.S. 34-32:5-116 or C.R.S. 34-32-116, each yeaz, 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, new disturbances that aze 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 yeaz, if any. <br />Please attach vour revised written annual renort and annual report map to this form. The Anuual <br />Report & Fee requirement is not met until we have received the following components: fee. report, and <br />associated map. If no new disturbances or reclamation have occurred durinti the previous vear and no <br />new chanties to the previous year's map are necessary, then uo new map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />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: Dennis C. Morrison <br />Permittee Name: <br />Address: <br />Larimer County <br />P.O. Box 1190 <br />Fort Collins, CO 80522 <br />Phone Number: (970) 498-5652 <br />Fax Number: (970) 498-5678 <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 />e osed. ~~~ \ `\ <br />Signature of Corporate rcer, Owner, or Designee <br />1~ \`~ O~ <br />Date ~ <br />M:~PERhIl'1\MASTERDOCUMINPSVvfAF-04 <br />