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• Q�1��11111 • C� 4�3"RECEIVED <br /> FEB 0 1 2001 <br /> ANNUAL FEE and REPORT REQUEST <br /> Division of Minerals and Geology <br /> PERMITTEE NAME: Charles W Houchin <br /> PERMIT NO.: M-1980-249 <br /> OPERATION NAME: Houchin Gravel Pit <br /> ANNIVERSARY DATE: February 4, 2001 <br /> ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br /> COUNTY: El Paso <br /> According to C.R.S. 34-32.5-116 or C.R.S. 34-327116. 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.yeaT—newdisturbances 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 annual report and annual report man to this form. Please note that an <br /> adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br /> report. <br /> Division records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: <br /> Permittee Contact: Charles Houchin <br /> Perm ittee Name: Charles W Houchin <br /> Address: P.O. Box 162 <br /> Green Mountain Falls, CO 80819 <br /> Phone Number: (719) 684-9285 <br /> Fax Number: (715) 684-2695 <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 /> Signature of Corporate Officer or Owner <br /> j -3 O <br /> Date <br /> Tito l <br /> Al TERWT AASTERDOCUMENTSW-AF-01 <br />