2005-06-20_REPORT - M1987078

• Permit No: M1987078
• IBM Index Class Name: Report
• Doc Date: 6/20/2005
• Doc Name: Annual Fee/Report/Map
• From: seifert construction
• To: dmg
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE
ANNUAL FEE DUE:
COUNTY:
City of Lamar
M-1987-078
Lamar Park Grav Pit
June 24, 2005
$281.00 (Due on or before your anniversary date)
Prowers
=4H=f~P~,~.
JUN 2 02005
Drvisio7 of C9{p~rals & CeaioDf
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 shall submit the annual fee, a report a:.d map shce:ng the extent of current distucbances_to_affeoted_ __-
land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to
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 ymm revised written annnal rennrt and anm~al report m n this form- Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact:. Patrick Mason
Permittee Name: City of Lamar
Address: 102 E. Parmenter St.
Lamar, CO 81052
Phone Number:
Fax Number:
(719}336-4495
[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.
Stature of Corporate Officer, Owner, or Designee
- l`1- oS
Date
M:~PERMITVvIASTERDOCUMENTSNI-AF-04