Laserfiche WebLink
<br />ANNUAL FEE and REPORT REQUEST <br />RECEIVED <br />PERMITTEE NAME: <br />PERMPI' NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Cheyenne County <br />M-1999-083 <br />Rother Pit No. 1 <br />October 19, 2002 <br />DCT 16.2002 <br />Division of Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Cheyenne <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 />]and, 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 annual resort and annual resort maa to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may su~fce fora written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Lara Crowell <br />Permittee Name: Cheyenne County <br />Address: P.O. Box 567 <br />Cheyenne County, CO 80810 <br />' ~-' - `Phon~Nnmber: --(999) 767=5872° - - - <br />Fax Number: (719) 767-5540 <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 />~CGtt.C f ow2QQ . ~clrntnt <br />Signature o Corporate Of icer, Owner, or Designee <br />~~~f~~- <br />Da[ <br />M:U'ERM ITMASTERDOCUM ENTS~hf-AF-M <br />