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<br /> <br />112 Enclosure <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date: <br />Corn Construction Co <br />M-83-013- <br />LATHEM - BURKETT PIT <br />04/28/86 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />X Check or money order payable to Colorado Mined <br />Land Reclamation Division for annual fees due <br />S e~ ~ ~Q`" Annual Report <br />Map <br />Remdrks' !7~ h,i.,.~ C/ !~~//..., /ia~ ~c c~/ p~th,~ .Jc~, ,..f Jt`~. rfi/ocrr.~.-~ ~C.~/, <br />`yo ~+,n, .,5 / s r/~t, ~ A lc T>~,~ Cpl>,~ 7~,c ~~NI >~ )'~'~S 1~'-c <br />~i-~-~'G <br />Signature <br />