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� - III IIII IIIIIIII III <br /> 999 <br /> ANNUAL FEE and REPORT REQUEST <br /> RECOVED <br /> PERMITTEE NAME: Seifert Construction <br /> PERMIT NO.: M-1993-027 OCT 0 1 2001 <br /> OPERATION NAME: Schoolfield Pit Division of Minerals and Geology <br /> ANNIVERSARY DATE: October 4,2001 <br /> ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br /> COUNTY: Custer <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 to affected 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 your revised written annual report and annual report map to this form. Please [rote that air <br /> adequately labeled map that clearly delineates and includes the 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: Mary Seifert <br /> Permittee Name: Seifert Construction <br /> Address: 69+6A-I4wy-69-AF �q (� 1`CLY.d P L) e . i <br /> Westcliffe. CO 81252 <br /> Phone Number: (719) 783-2757 <br /> Fax Number: <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 /> Signatu e of Corporate Offi er or caner <br /> Date <br /> M:'PERM rM1 ASTER DOCU MENTSW-AF-01 <br />