Laserfiche WebLink
itil~~. <br />/~ h/~ <br />PERMTTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />i/' ANNiiAT. FF.E and REPORT RF.nTTF.ST <br />Lincoln County <br />M-1978-078-SG <br />George Ansley Pit <br />May 24, 2006 <br />~~c~~vE~ <br />`~ MAY Q 22006 <br />~Oiu{doa of MinarehaodGaalegr <br />$281.00 (Due on or before your anniversary date) <br />Lincoln <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-thahare 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 ypur revised written annual rennrt and anm~al reForf m n 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 />Petmittee Contact: Don Blake <br />Permittee Name: Lincoln County <br />Address: P.O. Box 39 <br />Phone Number: <br />Fax Number: <br />Hugo, CO 80821 <br />(719)743-2337 <br />(719)743-2815 <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 />~rtv~ ~~r~ir-ee.-~ <br />Signature of Corporate Officer, Owner, or Designee <br />O~ 1C3- o~ <br />Date <br />M:V'EAMI7IMASTERDOCUM ENTSN-I-AF-04 <br />