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C~ <br />~/ ANNITAi. t7F.F. wnd ARi~RT Rli_A7TFCT <br />PERMTI`I'EE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~ Lake co.aty <br />~-1977-071 <br />Half Moon Pit <br />May 25, 2006 <br />RECEIVED <br />~~ MAY 2 5 20~ <br />~ Division st Minarala and OesIoAY <br />5688.00 (Due on or before your anniversary date) <br />Lake <br />Accbrdirig to C.R.S. 3432.5-I 16 or C.R.S. 3432-1 I6, each year, on the armiversary date of the permir, an <br />operator shall submit the amoral fee, a report and map showing the extort of current disturbances ro atiecud <br />land, reclamation accomplished ro date and during the preceding year, clew disturbances drat are anticipated ro <br />occur doting the upcoming year, reclamation that .vr71 be performed doting the corning year, the dates for the <br />beginning of active operations, and the date active operations rx~d for the year, if any. <br />Please Mach ynor reviamt written anmml report and annual emnrt ~na„nr to this form_ PIEQSe Hate drat act <br />adequately labeled map that clearly Delineates and includes the above elements ntay suffux jor a written <br />report. <br />Division records indicate the following petmittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Brad Palmer <br />Pernrittee Name: Lake County <br />Address: P.O. Box 964 <br />Leadville, CO 80461 <br />Phone Number: (719) 486-0259 J, /` <br />Fax Number: (719) 4 ~ ~ ~' ~-f Q~p ~ g Y ~9 ~ <br />If you have additional comments a~/or information that slmttld be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Armtial Report insinrctions are <br />enclosed. ,. n <br />Signature of Corporate Officer, Owner, or Designee <br />~~/lam/0/ <br />n~-~ <br />9Y1-! E00/E00'd 92f-1 9019ZE9EOEl+ R/alaa7 ! sleiaulN to uoislni0 opeiola7-NOtld 9E~Oi 900Z-AY11-91 <br />