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if},iii <br />~y <br /> ANNiiAI. FFF and RF,PORT R F,OiTFST ~~f°~"paAA'rti <br />c <br /> ~CT 2 i 2CD5 <br />PERMITTEE NAME: <br />PERMIT NO,: Y 'Elbert County <br />UM-2001-056 ~ o~~~~~~~ U~ rv~...:~,t: & Gxuloyy <br />OPERATION NAME: $elveal Gravel Pit <br />ANNIVERSARY DATE: November 9, 2005 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Elbert <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 written annnal rgpnrt and annual re nrn t man 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: Tim Sheridan <br />Permittee Name: Elbert County <br />Address: 809 Ute Ave <br />Simla, CO 80835 <br />Phone Number: (719) 541-2268 <br />Fax Number: (719) 541-2826 <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 />enclosed. <br />Signature of Corpor^ to Officer, O er or-D signee <br />~~ ~~ o~ <br />Date <br /> <br />M:~PERMI7IMASTERDOCnMEN7'SVvf-AF-04 <br />