2004-07-14_REPORT - M1978266

• Permit No: M1978266
• IBM Index Class Name: Report
• Doc Date: 7/14/2004
• Doc Name: Annual Fee/Report/Map
• From: Jackson County
• To: DMG
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Jackson County
M-1978-266
Riley Gravel Pit
August 15, 2004
N
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RECEIVE®
JUL 14 2004
Division of Minarets antl Geology
$281.00 (Due on or before your anniversary date)
Jackson
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-and during_th~precedingyear, new disturbances that are anticipated to
occur during the upcoming year, reclamation that will be performed during the coming year, `the dafes for the-
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach ynnr revised written annual report and anneal re~nrt ma,~n, 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: Nelson W. Selcer
Permittee Name:
Address:
Phone Number:
Fax Number:
Jackson County
P.O. Box 488
Walden, CO 80480
[phone]
[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.
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Signature of Corporate Officer, Owner, or Designee
Date ~ ~'b~
M:~PERMINNASTERDOCUMEMSM-AF-09