2005-05-31_REPORT - M1979210

• Permit No: M1979210
• IBM Index Class Name: Report
• Doc Date: 5/31/2005
• Doc Name: Annual Fee/Report/Map
• From: Morgan County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:

Morgan County
M-1979-21o MAY ~ t 2005
Vancil Pit - r;,; ~ ^~"Ir'17
May 4, 2005
$688.00 (Due on or before your anniversary date)
Morgan
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 and map showing the extent of current disturbances to_affected___~
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 your revised written annnal report and annnal reQnr m P to this form- 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 pennittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Joe B. Baltazar
Permittee Name: Morgan County
Address: 17303 CR S
Phone Number:
Fax Number:
Fort Morgan, CO 80701
[phone]- -
[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.
or Designee

Date
l~ 0~
M:~PERMITMASTEADOCUMENTSM-AF-04