2006-03-02_REPORT - M2002017

• Permit No: M2002017
• IBM Index Class Name: Report
• Doc Date: 3/2/2006
• Doc Name: Annual Fee/Report/Map
• From: Lincoln County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
~~C~IV~D
1/ANNiTAi. FF.F, and RF,P(lRT RF(?iTF.ST
~ Lincoln County
M-2002-017
O'Dwyer
March 26, 2006
MAR 0 2 2006
~p1y151®n ®f Miaemis ana Geology
$281.00 (Due on or before your anniversary date)
Lincoln
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
land, reclamation accomplished to date and during the preceding year, new disturbances that are anttcip'ate8~' --
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 anneal refit and anneal re nr m n 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:
Petmittee Contact: Don Blake
Permittee Name: Lincoln County
Address: P.O. Box 39
Hugo, CO 80821
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
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Date
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