2003-01-15_REPORT - M1979216

• Permit No: M1979216
• IBM Index Class Name: Report
• Doc Date: 1/15/2003
• Doc Name: Annual Fee/Report Notice
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

Fremont County
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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
M-1979-216
Dist No 2 Gravel Pit

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JAN 15 2003
Division of Minerals and Geolac~y
January 20, 2003
$Z81.00_(Due~on or before your anniversary date)
Fremont
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 [o affected
land, reclamation accomplished [o date and during the preceding year, new disturbances that are anticipated to
occur during the upcoming year, reclamation [hat will be performed during the coming year, [he dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach y~nur revised written annual rennrt and annual red or 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: Terry Acton
Permittee Name: Fremont County
Address: Fremont County Commissioners
615 Macon Ave., Room #105
Canon City, CO 81212
Phone Number. [phone]
Fax Number: {719) 275-7626
If you have additional comments andlor 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 instmctions are
enclosed.
Si~a~ure of Corporate Officer, Owner, or Designee
I-~-®~
Date
M:IPERMITV.1ASTERD000MENTSNI-AF-04