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^.' <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~ l ~ p i REC~~~~~D <br />ANNiJAL FEE and REPORT REQUEST ~ N 0 4 2001 <br />Washington Couuty ~/ <br />/~I-1997-015 <br />Elrick Pit <br />December 19, 2006 <br />Division of Reclamation, <br />Mining and Safety <br />$$688.00 (Due on or before your anniversary date) <br />Washington <br /> <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_So_a1~~cte51_land, __ <br />reclamation accomplished to date and during the preceding 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 vour revised written annual resort and annual report map to this form. The Annual Repots <br />& Fee requirement is not met until we have received the following components: fee, repots, and associated <br />map. If no new disturbances or reclamation have occurred durinc the previous vear and no new chances to <br />the previous year's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Auuual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Jesse Stackhouse <br />Permittee Name: ~Washingto County ~i~.~•vt ~O i/ - `~-Ods /~ <br />Address: 501 4th Ave d..a~. g~0(~ (.J$ ~~~ <br />/ ~ ,3 -~~~~i i ayf o~ a-e..Q <br />Otis, CO 80743 ~r,,,.,~,~ Gl.r2r~ ,[}s~Q- <br />Phone Number: (970) 246-3347 /yd ~~.,.,_,~_~~ ~_ <br />Fax Number: S A n+~ ~ ~~~ <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 />LLB <br />gnature of C' orate Officer, Owner, or Designee <br />/ ~ - //- 2oaG <br />Date <br />