2001-11-21_REPORT - M1995017

• Permit No: M1995017
• IBM Index Class Name: Report
• Doc Date: 11/21/2001
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

III IIIIIIIIIIIII III
999
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REQUEST
Lee Roy and Marlene J Rothe
M-1995-017
Rothe Sand & Gravel Pit
December 18, 2001
~~~~~~: -
Division otlNinerals and Geology
$281.00 (Due on or before your anniversary date)
Logan
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, areport-and map showing the extent of current disturbances to aaffected and,
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 your revised written annual report and annual report map to this farm. Please note thnt an
adequately labeler/ map that clearly delineates and includes the above elements may since for a written report.
Division records indicate [he following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Lee Roy Rothe
Permittee Name: Lee Roy and Marlene J Rothe
Address: !9727 Factory St.
Sterling, CO 80751
Phone Number: [phone]
Fax Number: [phone]
]f you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it [o this form along with your written report and map. Annual Report instructions are enclosed.
ignature of Corp to Officer or Owner
1\- 20-01
Date
M:~PE R M n V.1 A ST E R D OC U M ENTSVv1-AF-01