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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br /> <br />Melvin~T Gydesen <br />M-1982-020 <br />Lucky Strike Lode <br />May 25, 2003 <br />C <br />RECE fVED <br />MAY 16 ~j~ <br />DiviSjyA If IHlptl~ ~f f720(6~y <br />$225.00 (Due on or before your anniversary date) <br />Gunnison <br />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 />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach ymn• revised written anneal rennrt and annual report map to this form- Please note that an <br />adequately labeled map that~cle/a}r~ly delineates~aj~n~d i~nclu~des the above elements m~a¢su~ffi'ce for a written <br />report. -~+ ~yl / / i !~~J~"r'~-`~ ~ ~ ~~V ~~~ <br />Division records ind/icat~e the followi~rmittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Melvin Rpp.~~Gydesen <br />Petrnittee Name: MelvinVi(iydesen <br />Address: 229 CR 11, Space No. 21 <br />Gunnison, CO 81230 <br />Phone Number: (970) 641-2399 <br />Fax Number: <br />~~~ v/N ~ ~eSen~ <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~ma~p~A~nnual Report instructio,~nsare~ <br />enclosed. ~.~"`.'" ~ /Z~~~~ <br />,,// <br />1`.-_ <br />Signature of Corporate Offi ,Owner, or Designee <br />Date .~Si~~~~'l,~^-c (S~ ~~ ~ <br />M:~PERMITMASTERDOCUMENTS/M-AF-02. nOC <br />