2006-10-25_REPORT - M1982189

• Permit No: M1982189
• IBM Index Class Name: Report
• Doc Date: 10/25/2006
• Doc Name: Annual Fee/Report/Map
• From: Kit Carson County
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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/ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
~K/it Carson County
~I-1982-189
Hornung Pit
October 28, 2006
$281.00 (Due on or before your anniversary date)
Kit Carson
~% OCT 2 5 2006
vpivision of Reclamation,
Mining and Safety
According-ta C:R:S:-34=32:5-116 or C.R:S: 34-32-116; eacfi year; on the anniversary ate of the permit, an
operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected
land, reclamation accomplished to date and during the preceding year, new disturbances that aze 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 vour revised written annual report and annual report man to this form. The Annual
Report & Fee requirement is not met until we have received the following components: fee, report, and
associated moo. If no new disturbances or reclamation have occurred during the previous veer and no
new chances to the previous year's moo are necessary, then no new moo is required, provided that the
Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly
delineates and includes the above elements may since for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact:
Permittee Name:
Address:
Phone Number:
Fax Number:
If you
below
J
Date
Lyn Brownfield
Kit Cazson County
P.O. Box 160
Burlington, CO 80807
[phone]
[phone]
5otnments and/or information that should be provided to the Division, please provide it
this form along with your written report and map. Annual Report instructions are
or Designee
M:~PERMITMASTERDOCUMEN'1'SVv1-AF-04