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d~ <br />~~~~i <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Larimer County <br />M-1985-135 <br />Horton Gravel Pit <br />January 31, 2004 <br />JAN 1 5 200~t <br /> <br />~l7iSi0n of Mineral; ..-. _... <br />$688.00 (Due on or before your anniversary date) <br />Larimer -tea <br />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 <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-aad-during-the precedingyear,-new-disturbances-that are anricipated-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 revised written anmral rennrt and annual re nn rt mxn to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice 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: Dennis C. Morrison <br />Permittee Name: <br />Address: <br />Larimer County <br />P. O. Box 1190 <br />Fort Collins, CO 80522 <br />Fax Number: ...~II~m o~~'z ^~'~ <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 />Signature of Corporate Officer, caner, or Designee <br />~o.~, ~3 ~.oo", <br />Date ~ <br />M:\PERM ITNAASTFR DOCUMENTSVvI-AF-04 <br />