2006-07-10_REPORT - M1981085

• Permit No: M1981085
• IBM Index Class Name: Report
• Doc Date: 7/10/2006
• Doc Name: Annual Fee/Report/Map
• From: N Colo Water Conservancy Dist
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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~/ ANNTTAT. FFF, and RFP(7RT RF.t?T1F.AT
PERMITTEE NAME:
PERMff NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
N Colo Water Conservancy Dist
/M-1981-085
Riprap Quarry Area
July 21,2006
RECEIVED
~JUL ~ 0 2006
~ivision ~f Minerals and Geolosy
$688.00 (Due on or before your anniversary date)
Grand
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 shall submit the annual fee, a report and map showing the extent of current disturbances to affected
land; reclamation°accomplished to date-and during~the preceding year, new°disturbances-that are anticipated to
occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach ynnr revised written annnal re~nnrt and anm~al regQrt main to this form- Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Jim Struble
Permittee Name: N Colo Water Conservancy Dist
Address: 220 Water Avenue
Berthoud, CO 80513
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or ,information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
Signature of Corporate Officer, Owner, or Designee
Date
M:~PERMITMASTERD000MENTSN-7-AF-04