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~~,~ k' <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~/ ANNUAL FEE and REPORT REQUEST <br />Kit Carson County <br />/M-1988-115 <br />Ostrowski Pit <br />December 19, 2006 <br />~% IrOV 2 8 2006 <br />Divisioncl:;. ~ra,ation, <br />iNining and Safefy <br />$$281.00 (Due on or before your anniversary date) <br />Kit Carson <br />i~L <br />it ~~~~ <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-11616+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 vour revised written annual report and annual resort maa to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred durinti the previous vear and no <br />new chanties to the urevious year's mau are necessary, then no new map is required, arovided that the <br />Ouerator shall state this in the Annual Resort. Please note that an adequately labeled map that clearly <br />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: ;~ n J <br />Permittee Contact: Lyn Brownfield ,L.lJ,t1i I I1~Ci.l~ ~1 <br />Permittee Name: Kit Carson County <br />Address: P.O. Box 160 <br />Burlington, CO 80807 <br />Phone Number: (719) 346-8139 <br />Fax Number: (719) 346-7242 <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 />of <br />Owner, or Designee <br />MIPERMINAASTERDOCUb1ETTfSUvf-AF-04 <br />