2007-03-22_REPORT - M2002017 - Laserfiche WebLink

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~ ~~ ~~~ ANNUAL FEE and PORT REQUEST PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNNERSARY DATE: ANNUAL FEE DUE: COUNTY: Lincoln County ~zooz-o17 O'Dwyer March 26, 2007 .~~ ~ ry ~ ~~ rh~R?~z~A,~ ~i~j~93R c„ tKn9rajt ~' ~df~,ty~' $$281.00 (Due on or before your anniversary date) Lincoln 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 the preceding year, new disturbances that are anticipated to occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning of active operations, and the date active operations ceased far the year, if any. Please attach your revised written annual report and annual report man to this form. The Annual Report & Fee requirement is not met until we have received the following components: fee, reaor4 and associated map. If no new disturbances or reclamation have occurred during the previous year and no Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. Division records indicate the following permittee contact information. Please verify and make any necessary changes: Permittee Contact: Don Blake Permittee Name: Lincoln County Address: P.O. Box 39 Phone Number: Fax Number: Hugo, CO 80821 (719) 743-2337 (719)743-2815 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 enclos ~~~~ Signature of Corpp ate Officer, Owner, or Designee ~~~C~ ~ ~~ 2~1~~ Date M:WERMITVMASTERD000MENTSUI-AF-04