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>~--~_~~ <br />ANNUAL F~E an REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Lincoln County <br />r/M-1987-016 <br />County Line Pit <br />Apri17, 2007 <br />~r-~q-~~.9^~ <br />. •. <br />~~"~ 0 9 2007 <br />py'iision o~ R~.c~..nt:UOn, <br />(Vining and Sctcty <br />$$281.00 (Due on or before your anniversary date) <br />Lincoln <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_prticeding year, new disturbances that are anticipated to_ <br />occur during the upcoming year, reclamation that will be performed during the coming yeaz, the dates for the <br />beginning 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 <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 during the urevious vear and no <br />new chanties to the urevious year's man are necessary. then no 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 suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Dan Blake <br />Permittee Name: Lincoln County <br />Address: P.O. Box 39 <br />Hugo, CO 80821 <br />Phone Number: (719) 743-2337 <br />Fax Number: (719) 743-2815 <br />./O~/O~afl /e Cr/J/ /PSi~~,/P~jP' G~~i 2 <br />/-- ~_` <br />,!~ /Pac1~ P~ c~t719-7~/3-,2337 <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 />enclosed. ////~~ ~~ yy---~ /~ <br />~ i7ilil~/l~~ //1~iJ> <i~~~ GG - f r <br />Signature of Co orate Officer, Owner, or Designee <br /> <br />M:IPERMITMASTERDOCUMENTSUI-AF-00 <br />