Laserfiche WebLink
3-0 <br /> • sss <br /> ANNUAL FEE and REPORT REQUEST <br /> PERMITTEE NAME: Sedgwick County <br /> 9 h <br /> PERMIT NO.: <br /> OPERATION NAME: Dolezal Gravel Pit NO a 7 20D <br /> ANNIVERSARY DATE: November 8,2000 `livision of Tina ''' ild Geology <br /> ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br /> COUNTY: Sedgwick <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 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 your revised written annual report and annual report map to this form. Please note that an <br /> adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br /> report. <br /> Division records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: <br /> Permittee Contact: Randy Renquist <br /> Petmittee Name: Sedgwick County <br /> Address: 223 S. Cedar <br /> Julesburg,CO 80737 <br /> Phone Number: (970) 474-3576 G ,, // <br /> Fax Number: (970) 474-0954 / 0 t q - 3 5 S g <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 /> Signature of Corporate 6fficer or Owner <br /> Date <br /> M WERWRMASTERDOCUMENTSW-AF-OI <br />