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~S <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br /> <br />Morgan County <br />M-1979-21o MAY ~ t 2005 <br />Vancil Pit - r;,; ~ ^~"Ir'17 <br />May 4, 2005 <br />$688.00 (Due on or before your anniversary date) <br />Morgan <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 <br />_ _ _operator shall submit_the annual fee a report and map showing the extent of current disturbances to_affected___~ <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annnal report and annnal reQnr m P to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. <br />Division records indicate the following pennittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Joe B. Baltazar <br />Permittee Name: Morgan County <br />Address: 17303 CR S <br />Phone Number: <br />Fax Number: <br />Fort Morgan, CO 80701 <br />(970) 562-3560- - <br />(970) 562-3569 <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 <br />enclosed. <br />or Designee <br /> <br />Date <br />l~ 0~ <br />M:~PERMITMASTEADOCUMENTSM-AF-04 <br />