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<br />~~~~OC9f~l~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />San Miguel County <br />M-1981-154 <br />Norwood Pit <br />November 20, 2004 <br />$688.00 (Due on or before your anniversary date) <br />San Miguel <br />NOIJ i :' 2C04 <br />Division of f!v'ineci; ~~. ny ~1~~71 <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 preoeaing yeA%riaw di§tur5arice's~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 annnal report and annnal res nrt m ~n to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice 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: Mike Horner <br />Permittee Name: San Miguel County <br />Address: P.O. Box 426 <br />Norwood, CO 81423 <br />Phone Number: (970) 327-4835 <br />Fax Number: (970) 327-4090 <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 farm along with your written report and map. Annual Report instructions are <br />enclosed. <br />Signatu~ rporate~ er, or Designee <br />l/~~7, <br />Date <br />M:IPERMI'I~bfASTERDOCUMENTSUI-AF-04 <br />