2006-09-19_REPORT - M1977184 - Laserfiche WebLink

Home Browse Search

ANNUAL FEE and REPORT REQUEST PERMTITEE NAME: PERMIT NO.: OPERATION NAME: ANNNERSARY DATE: ANNUAL FEE DUE: COUNTY: City of Fort Collins M-1977-184 Timberline Pit August 15, 2006 a ., SFp '' 9 200 i Division of Reclamat!on, fvun:ng eno S~.e ;~ $688.00 (Due on or before your anniversary date) Lorimer 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 shalLsttbmit the_annuaLfee,_a_report_and_map_showing theytent.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 your revised written annual report and annual reuort man to this form. The Annual Report & Fee requirement is not met until we have received the following components: fee, resort, and associated maa. If no new disturbances or reclamation have occurred during the arevious vear and no Operator shall state this in the Annual Report. Please note that an delineates and includes the above elements may since for a written report. map that clearly Division records indicate the following permittee contact information. Please verify and make any necessary changes: Permittee Contact: Mark Sears Permittee Name: Address: City of Fort Collins P.O. Box 580 Fort Collins, CO 80522 Phone Number: (970) 221-6600 Fax Number: 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. //. Sign a of Corporate Officer or Owner 9/i~~oG Date