2005-06-29_REPORT - M1982094

• Permit No: M1982094
• IBM Index Class Name: Report
• Doc Date: 6/29/2005
• Doc Name: Annual Fee/Report/Map
• From: kit carson county
• To: dmg
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Kit Carson County
M-1982-094
Kit Carson County
June 24, 2005
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~~vision o(Minerals and Geology
$281.00 (Due on or before your anniversary date)
Kit Carson
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 cun•ent disturbances to affected
land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to
occur during the upcoming 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 affa~ynnr revived wriffen anneal report and anneal re nr~f_man fn fhis form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact:
Permittee Name:
Address:
Phone Number: [phone]
Fax Number: [phone]
Lynda Brownfield
Kit Carson County
P.O. Box 160
Burlington, CO 80807
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If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it ty~this form along with your written report and map. Annual Report instructions are
or Designee
Date
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M:IPERMI'MfASTERDOCUMENTSVN-AF-04