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H b l~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />v~ ANNUAL FEE and REPORT REQUEST <br />V Frank Laughrey <br />,~ M-1991-082 <br />Tiger Timber Site <br />March 17, 2006 <br />RECE~~. <br />Mar p.3 ~ <br />~pivision o1 ~ioe,xrv- s.:_ . <br />$281.00 (Due on or before your anniversary date) <br />Teller <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 <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 duringlhe_preceding_year,new_disturbances_thatare-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 your revised written annual report and annual report map to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: <br />Permittee Name: <br />Address: <br />Frank Laughrey <br />Frank Laughrey <br />P.O. Box 128 <br />Lake George, CO 80827 <br />Phone Number: (719) 748-3621 <br />Fax Number: - - -. _ . _ . <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 />~. ~l~ <br />Signature of Corpora e Office or Owner <br />~ -G ~ Ofo <br />Date <br />