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00 <br /> 999 <br /> ANNUAL FEE and REPORT REQUEST RECEIVED <br /> DEC 1 3 1000 <br /> PERMITTEE NAME: Lee Roy and Marlene J Rothe <br /> PERMIT NO.: M-1995-017 t Division of Minerals and Geology <br /> OPERATION NAME: Rothe Sand & Gravel Pit <br /> ANNIVERSARY DATE: December 18,2000 <br /> ANNUAL FEE DUE: $281.00(Due on or before your anniversary date) <br /> COUNTY: Logan <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.shawing.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 vour revised written annual report and annual report map to this form. Please note that an <br /> adequaiely labeled map that clearly delineates and inchides 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 /> Pemtittee Contact: Lee Roy Rothe <br /> Permittee Name: Lee Roy and Marlene J Rothe <br /> Address: 19727 Factory St. <br /> Sterling, CO 80751 <br /> Phone Number: (970) 522-2281 <br /> Fax Number: (970) 522-2282 <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 Co rate Officer or Owner <br /> Date <br /> M.NERMINAASTERDOCUMENTSN-AF-01 <br />