2005-11-10_REPORT - M1979158

• Permit No: M1979158
• IBM Index Class Name: Report
• Doc Date: 11/10/2005
• Doc Name: Annual Fee/Report/Map
• From: Colorado City Metropolitan District
• To: DMG
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
~olorado City Metropolitan District
t' M-1979-158
Mountain Shadows Pit
December 20, 2005
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$688.00 (Due on or before your anniversary date)
Pueblo

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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 ~ryn• revised wriften anm~al report and anm~al report morn to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written
report,
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Frank Main
Permittee Name: Colorado City Metropolitan District
Address: 4497 Bent Brothers Blvd
P. O. Box 19390
Colorado City, CO 81019
Phone Number: [phone]
Fax Number: [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 insfructions are
enclosed.
Signature of Corporate Officer, Owner, or Designee
Date
M:NERMnU4ASCERDOCUMF.NTS4M-AF-04