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FiECE6VED <br />OCT 0 8 2002 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Lincoln County <br />M-1977-163-SG <br />Fisher Pit <br />November 21, 2002 <br />Division of Minerals and Geo{ogy <br />$688.00 (Due on or before your anniversary date) <br />Lincoln <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br />_ operator shall submit the annual_fee, a report and map showin the_exten[ Qf.cprrent-disturbances to_affec[ed_ -. <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during [he coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual reuort and annual report maa to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. <br />Division records indicate the following petmittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: -$erf~I~ <br />Permittee Name: Lincoln County <br />Address: P.O. Box 39 <br />Phone Number: <br />Fax Number: <br />Hugo, CO 80821 <br />{719)743-2337 <br />(719) 743~.283~ <br /> <br /> <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. <br />IL /tSY~ <br />Signature of Corporate Officer, Owner, or Designee <br />~~- ~3^ ~~ <br />Date <br />M:~PERMITUTASTERD000MENTSVN-Ar-M <br />