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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Ranch Land LLC <br />M-2003-021 <br />Ranch Land Rock Pit #2 <br />March Z2, 2005 <br />$688.00 (Due on or before your anniversary date) <br />Fremont <br />RECEIVED <br />MAR 2 2 2W5 <br />Dirision of Mirrarals antl Geology <br />According to C.RS. 3432.5-116 or C.RS. 34-32-116, each year, on the armiversdry date of the permit, an operator <br />sha11 submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding-year, new distutbancaes that are anticipated to occur <br />during the upcoming Year, reclamation that will be performed during the coming Year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revieed written annual report and annual ~nnrt main Chic fnrm_ Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may su,Bice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: William Peetz <br />Petmittee Name: Ranch Land LLC <br />Address: 3925 Hill Circle <br />Colorado Springs, CO 80904 <br />Phone Number: (719) 492-0266 <br />Fax Number: (719} 473-5444 <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-fQrrrr along with your written report and wrap. Annual Report insh'uctions are enclosed. <br />~/~ ~e~ <br />Signature ~ ~~ a Officer, Owner~ee ' <br />3~i/~a 5- <br />Date <br />