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,~_ ~,~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />"Logan County <br />//M-1983-187 <br />Kues Gravel Pit <br />November 8, 2005 <br />~ ; ~m~ <br />$688.00 (Due on or before your anniversary date) <br />Logan <br />e 6m <br />r <br />__ According to C.R.S. 34.32.5116 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 />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated 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 ym~r revis d written annnat report and annnal report m to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since 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: Byron D. Hickox <br />Permittee Name: <br />Address: <br />Logan County <br />315 Main St., Ste. 2 <br />Sterling, CO 80751 <br />Phone Number: (970) 522-0888 <br />Fax Number: (970) 522-4018 <br />~ ~ r <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 />~. <br />Signatur Co rate Officer, Owner, or Designee <br />// -/ ~-~S <br />Date <br />M:IPERMITNIASTERDOCUMENTSUI-AF-04 <br />