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i_ <br />RECEIVED I ~-- <br />APR 3 0 2002 <br />Division of Minerals and GeolagY <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Park County <br />PERMIT NO.: M-1995-027 <br />OPERATION NAME: Ansley Flat Pit <br />ANNIVERSARY DATE: May 8`h, 2002 <br />ANNUAL FEE: $281,00 (Due on or before anniversary date) <br />COUNTY: Park <br />According to C.R.S. 34-32.5 or C.R.S. 34-32-116, each yeaz. On the anniversary date of <br />the permit, an operator shall submit the annual fee, a report and map showing the extent <br />of current disturbances to affected land, reclamation accomplished to date and during the <br />preceding year, new disturbances that aze anticipated to occur during the upcoming year, <br />the dates for the beginning of active operations, and the date active operations ceased for <br />the year, if any. <br />Please attach vour revised written annual report and annual resort maa to this <br />form. Please note that an adegttately labeled map that clearly delineates and inchides <br />the above elements may stiff ce for a written report. <br />Division records indicate the following permittee contact information. Please verify and <br />make any necessary changes: <br />Permittee Contact: _Dou? K~i±h <br />Permittee Name: Park Countv <br />Address: P.O. Box 147 <br /> _Fairplay, Co 80440 <br />Phone Number: 719 836-4270 <br />Fax Number: (719) 836-4275 <br />If you have additional comments and/or information that should be provided to the <br />Division, please provide it below or attach it to this form along with your written report <br />and mnnu~ructions are enclosed. DI-eetor, park Ceudly <br />~ / Road and Bridae Deosrtim.M <br />Off cer or Owner <br />