Laserfiche WebLink
ON <br /> i <br /> 999 <br /> ANNUAL FEE and REPORT REOUEST <br /> RE EI1/ED <br /> PERMITTEE NAME: Prowers County AU 2 3 2001 <br /> PERMIT NO.: M-1984-136 Division of inerals and <br /> OPERATION NAME: Brann Pit D°pI09Y <br /> ANNIVERSARY DATE: August 31,2001 <br /> ANNUAL FEE DUE: $28.1.00(Due on or before your anniversary date) <br /> COUNTY: Prowers <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, new disturbances (hit are anticipated to <br /> occur during the upcoming year, reclamation that will be performed during the coming ye it, the dates for the <br /> beginning of active operations, and the date active operations ceased for the year, if any. <br /> Please attach your revised written annual report and annual report map to this form. Please note that an <br /> adequately labeled map that clearly delineates and includes the above elements may s ice for a written <br /> report. <br /> Division records indicate the following permittee contact information. Please verify and nake any necessary <br /> changes: <br /> Permittee Contact: Donald Koehn r <br /> Permittee Name: Prowers County P uJ Or LD <br /> Address: 109 E. Sherman St. -ZDI E, r A <br /> Lamar, CO 81052 cs'm L1 IA D <br /> Phone Number: (719) 336-5536 (o <br /> Fax Number: (719) 336-9633 33,6 — cite 33 <br /> If you have additional comments and/or information that should be provided to the Divisio i, 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 /> Signature of Corporate Officer or Owner <br /> Date <br /> M SPERM rRMASTERDOCUM ENTS\M AF-04 <br />