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ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMiT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Lee Roy and Marlene J Rothe <br />M-1995-017 <br />Rothe Sand & Gravel Pit <br />December 18, 2002 <br />$281.00 (Due on or before your anniversary date) <br />Logan <br />RECEIVED <br />JAN Z 4 2003 <br />DIYISIOn of Minerals and Geology <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 operator <br />shall submit_the_annual fee, a report and map showing-the-extent of current disturbances to affected land, <br />rec amahon accomp is e to ate an unng t e preceding year, new tstur antes that are annctpated to occur <br />during the upcoming year, reclamation that will 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 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 suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Lee Roy Rothe <br />Permittee Name: Lee Roy and Marlene J Rothe <br />Address: 19727 Factory St. <br />Sterling, CO 80751 <br />Phone Number: (970) 522-2281 <br />Fax Number: -(970) 522-2282- - ---- <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 />t,t~ <br />Signature of oepor e Officer, Owner, or Designee <br />-' I S' - [3 <br />Date <br />M:NERMITUTASTERD000MENTSUI-AF-01 <br />