2006-06-19_REPORT - M1985040

• Permit No: M1985040
• IBM Index Class Name: Report
• Doc Date: 6/19/2006
• Doc Name: Annual Fee/Report/Map
• From: Seifert Construction
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNIiAT, FF.F, and RF.PnRT RF.OTiF.ST
Seifert Construction
t~M-1985-040
Seifert Pit
Juue 18, 2006
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~~ JUN 19 2006
" DluislonofMinaratsandGeology
$688.00 (Due on or before your anniversary date)
Custer
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
shalt submit the annual fee,-a-report and map showing the. extent of current disturbances to affected land,
during the upcoming year, rec]amation that will be performed during the coming year, the dates for the
of active operations, and the date active operations ceased for the year, if any.
Please attarh ynnr revised written anm~al report and anm.al rr;~nrt malt' to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written report.
Division mcords indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Mary Seifert
Permittee Name: Seifert Construction
Address: CF.PR.address 1
P.O. Box 305
Westcliffe, CO 81252-0305
Phone Number: [phone]
Fax Number _ [phone]
If you have additional comments and/or information that should be provided to the Divisien, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
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Signatwe of orpora e Officer, Dwner, or Designee
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Date