Laserfiche WebLink
~~~C <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />/~ y ,~~/ <br />ANNiiAi, FF.F, and RF.Pf1RT RF.( i~CT <br />~t County <br />M-1983-178 <br />Bent County Pit <br />November 2, 2005 <br />$688.00 (Due on or before your anniversary date) <br />Bent <br /> <br />i ~f ~ <br />According to C.R.S. 34-32.5-116 or C.R S 34-32-1.16, each year, on the anniversary date of the permit, an <br />l~tliiiii~~le-aka "• • ."' .''t~iowm~=€lte-exfen#¢iif~cu`~x~t-di'stt~rl3ance's-te"~affee~ed ' <br />~repet#-a~i~'nrap <br />a <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming yeaz, 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 attarhymn• revised written anneal report and anm.al report main to thic form. Please note that an <br />adequadely 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: Gary Pritchazd <br />Permittee Name: Bent County <br />Address: P.O. Box 350 <br />Las Animas, CO 81054 <br />Phone Number: (719) 456-2223 <br />Fax Number: (719) 456-0375 <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 />Signatur of Corporate Officer, Owner, or Designee <br />OGro,~1=/Z 11, moos <br />Dale <br />M:~PERMITNIASTERDOCUMENTSVN-AF-04 <br />