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~'S <br />ANNiiAi. FF.F, and RF.Pl1RT RF.OiTFCT <br />r/ <br />PERMITTEE NAME: Grand County Y~r^ <br />PERMIT NO.: M-1995-004 / JUN 2 % 2005 <br />OPERATION NAME: Inspiration Point e"~"~"` `i ~ ~ ~ ' ~'~ <br />ANNIVERSARY DATE: May 5, 2005 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Grand <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 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 your revised writt n anm~al r port and annnal re nn rt maT to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: M C. Branstetter Ken Haynes <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Grand County <br />467 E. Topaz Ave. <br />P.O. Box 9 <br />Granby, CO 80446 <br />(970)887-2123 <br />(970)887-3168 <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 instmctions are <br />enclosed. <br />1 / w <br />C~ <br />Signature of Co orate Officer, Owner, or Designee <br /> <br />Date <br />M:~PERMITMASTERDpCUMEN754N-AF-04 <br />