2006-07-10_REPORT - M1977459

• Permit No: M1977459
• IBM Index Class Name: Report
• Doc Date: 7/10/2006
• Doc Name: Annual Fee/Report/Map
• From: Lake County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
~ANNTiAT. FFF, and RF,PTTRT RF.OTiF.ST
+r Lake County
r/ M-1977-459
Lake County Grav Pit
RECEIVED
~JUL ~ 0 2006
r Division of Minerals end Geolo,y
July 8, 2006
$688.00 (Due on or before your anniversary date)
Lake
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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 shall submit the annual fee, a report and map showing the extent of current disturbances to affected
land, reclamation_ accomplished to date_an_d during the precedingyear, new disturbances that are anticipated to -
occur during the upcomirig year, 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.
Please attach vnnr revised written anm~al report and anneal repnN man to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Brad Palmer
Permittee Name: Lake County
Address: Road and Bridge
P.O. Box 964
Leadville, CO 80464
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
M:~PERMI'PMASTERDOCUMENTS~M-AF-04
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