Laserfiche WebLink
<br />J~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Park County <br />M-1980-014 <br />Eleven Mile Pit <br />April 1, 2004 <br />$688.00 (Due on or before your anniversary date) <br />Park <br />MAR 3 U cuu~ <br />Di~i;im of Mirerls & Gealegy <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 ynnr revised written anmral re~nrt and annual rep nP rt mgp to this Pnrm_ 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: Doug Keith ~e,.f /gNcL <br />Permittee Name: Park County ,? , ,a% l'0,__3„ <br />Address: P. O. Box 147 ~ D, r~wt l!/> <br />Fairplay, CO 80440 ~~~ G~ SO`IkO <br />Phone Number: (719) 836-4283 ~~/ g - gg~ - /,/2 8 Z <br />Fax Number: (719) 836-4275 <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 />~~~//,~~ <br />Signature of Corporate Officer, Owner, or Designee <br />3/z9~4/ <br />Date <br />M:~PEAMITVv1ASTERDOCUMENTSUr-AFA4 <br />