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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Dewitt Excavating <br />M-1983-132 <br />Dewitt Excavating <br />July 29, 2003 <br />~~cF~VF <br />u~~tston.f G p~~ O <br />Rf~neratSdnaCe%By <br />$281.00 (Due on or before your anniversary date) <br />Prowers <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 />Yeclamaion accomp-I'is~ed-to dale an8 "during the p3ecedin~ year, new disturbances that-are anticipated-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 ynnr revis d wrift n anmlal r nnrt and anneal rennrt m ~n fn this form- p(epSe note that an <br />adequately labeled 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: Terry Dewitt <br />Permittee Name: Dewitt Excavating <br />Address: 7395 U.S. Hwy. 50 W. . <br />Lamar, CO 81052 ~/~~~ /~ <br />Phone Number: (719) 336-4455 /~~~" ~ ir/~ <br />Fax Number: {719) 336-8150 ~ ~_ f~~ <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 />s~. ~~_ <br />of Corporate tcer, Owner, or Designee <br />Date <br />b <br />M:\PERMITV.IASTERD000MENTSVvi-AF-01 <br />