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f'~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~F ~ RPr <br />ANNUAL FEE and REPORT REQUEST <br />Lincoln County <br />M-1977-163-SG <br />Fisher Pit <br />November 21, 2007 <br />R~~F~VED <br />NOV p p2007 ~ <br />Division of ReGamatlon, ,may <br />Mining and Safety // <br />$$791.00 (Due on or before your anniversary date) <br />Lincoln <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 accomplishedto date_and during=We preceding-year; crew-diseu;}arn~~nat=a~ ~ pat` 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 your revised written annual report and annual report map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, resort, and <br />associated maa. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous year's moo are necessary, then no new moo is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: -43e~t$lake <br />Permittee Name: Lincoln County <br />Address: P.O. Box 39 <br />Phone Number: <br />Fax Number: <br />Hugo, CO 80821 <br />(719)743-2337 <br />(719)743-2815 <br />~~r\~p~ Mor~~sov~ <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 />Signa (e of Corporate Officer, Owner, or Designee <br />Date <br />M:~PERMITMASTERDOCUMEMS\M-AF-04 <br />