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Y-`. <br /> <br /> RE~+E~VE® <br />PERMITTEENAME: Lake County <br />PERMIT NO.: M-1977-459 ~UL 0 ~' ~~ <br />OPERATION NAME: Lake County Grav Pit <br /> Division of Minerals and Geology <br />ANNNERSARY DATE: July_8y2004 <br />ANNUAL FEE DUE: ~88.00,(Due on or before your anniversary date) <br />COUNTY: a e <br /> <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 />an ,reclamation accomph`sfiedgate and durtng tthe preceding year; new dtsturbances that are antrctpated 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 ynnr revised written anmral rennrt and annnel re nn rt maTtn 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: -3ettySairza <br />Permittee Name: Lake County <br />Address: Road and Bridge <br />P.O. Box 964 <br />Leadville, CO 80461 <br />Phone Number: (719) 486-0259 <br />Fax Number: (a=1~}al~ts9 ~I q - ~$G~ - g~7 q <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 />Sign re of Corporate Officer, Owner, or Designee <br />~~~~y <br />Date <br />M: W ERMITNIASTERDOCUMENTS~h1-AE-04 <br />