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Sep 17 07 Ol:Olp <br />International Web Works 1-719-473-5494 p. <br />Y - <br />PERMITfEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~~FJ" <br />ANNUAL FEE and REpP~O,RT REQUEST <br />Ranch Land, LLC / <br />M-21102-096 // <br />Ranch Land Rock Pit #1 <br />October 15, 2007 <br />RECEIVED <br />OCT ~ ~ 2007 <br />Dlvlalon of Reclematlon, ,/ <br />Mlnfng and Safety <br />$$791.00 (Une on or before your anniversary date) <br />Fremont <br />According to C.R.S. 34-32,5-11 G 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 reportt and map showing the extent-of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding yeaz, new disturbances that are anticipated to occur <br />_ _ during the_upcoming yeaz. reclamation that wilt be performed.during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised written aauual reoort and annual resort map to this form. The Anneal Report <br />& Fee requirement is not met unffi we have received the following components: fee, reoort, and associated <br />maD. if no new disturbances or reclamation have occurred durinE the previous year and no new changes to <br />[his in the Annual Renort. Please note that an adequately labeled map that clearly dedaneates and includes the <br />above elements may suffice for a written reporf. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: William Peetz <br />Permittee Name: <br />Address: <br />Ranch Land, LLC <br />3925 Hill Circle <br />Colorado Springs, CO 80904 <br />Phone Number: (719) 492-0266 <br />Fax Number: (719) 473-5494 <br />If you have ad ' 'peat comments and/or <br />below or a it to this fo along <br />~2 <br />Signature of Corporate Officer, Owner, Ali <br />/U` ~- Dom- ci <br />~rmation that should be provided to the Division, please provide it <br />written report and mxp_ Annual Report instructions are enclosed. <br /> <br />