2006-02-01_REPORT - M1977472

• Permit No: M1977472
• IBM Index Class Name: Report
• Doc Date: 2/1/2006
• Doc Name: Annual Fee/Report/Map
• From: Jackson County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

~~
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
v" ANNfiAi. FF.F. and RF.PtIRT RF.OiTF.ST
;/ Jackson County
M-1977-472
BLM East Gravel Pit
January 25, 2006
~~~~~~~~
'' FEB 011006
Division o/Minerals and Geology
$688.00 (Due on or before your anniversary date)
Jackson
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
-"' opa~atur slut su(5mit'the-anrmal'fee,-a-report-and-map-showing the-extent-of~current-disturbances-to-affected-----
]and, 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 for the year, if any.
Please attaG~ynnr revised written annnal retort and annnal re~nrt man to this form. 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: Nelson Selcer
Permittee Name: Jackson County
Address: 188 Grant Street
P.O. Box 488
Walden, CO 80480
Phone Number: [phone]
Fax Number: [phone]
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
enclosed.
Signature of Corporate Officer, Owner, or Designee
3c-D to
Date
M:IPEAMITIMASTEADOCUMENTSVv1-AF-04