Laserfiche WebLink
ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Glenn Southwick <br />PERMIT NO.: M-1986-007 RECEIVED <br />OPERATION NAME: Masonville Stone MAR 1 1 2002 <br />ANNIVERSARY DATE: March 11, 2002 pivision of Minerals and Geology <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Latimer <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamadon_accomplished.to-dateand_during.the_preceding_yeac,_new_dismrbances-that. are_anticipa[ed.to-occur-- __ <br />during the upcoming year, reclamation [hat will be performed during the coming year, [he dates for the beginning <br />of active operations, and [he date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report mau to this form. Please note that act <br />adequately labeled map that.cfearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes:. <br />Permittee Contact: Glenn Southwick <br />Permi[tee Name: .Glenn Southwick <br />Address: 220 W. CR 84 <br />P.O. Box 1103 <br />Wellington, CO 80549 <br />Phone Number: (970) 568-3579 <br />Fax Number: (970) 568-0602 <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 enclosed. <br />Signature of Corporate Officer or Owner <br />3-~-02 <br />Date <br />M:~PERMITU~IASTERDOCUMENTSV.I-AF-01 <br />saw, -e. <br />