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i~ c /~\fn ./(/~~fT <br />7 / \ I / <br />M <br />~=~c~ ~ o~ <br />/ ~ V - <br /> <br />PERMITTEE NAME: City of Fort Collins '6 ~" '"' <br />PERMTI' NO.: X141-1977-184 <br />OPERATION NAME: Timberline Pit <br />ANNNERSARY DATE: August 15, 2005 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Larimer <br />____~According~o C.R.S._34_32.5:1.16_o~C.R.S.~A,3Zll6,_each__yeazYonshe_anniversatysiate_olrthe_permit,_an- <br />operator shall submit-the_annUal fee,-a_report_and map_showing_the_ex[ent.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 note that an <br />adequately labeled map that clea delineates and includes the above elements may suffice for a written <br />report. i ~. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Mark Seazs <br />Permittee Name: City of Fort Collins <br />Address: P.O. Box 580 <br />Fort Collins, CO 80522 <br />Phone Number: (970) 221-6600 <br />Fax Number: <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 />~~ <br />Sign re of Corporate Officer, Owner, or Designee <br />P~~S/ds~ <br />Date <br />M:~PERMITN3ASTERDOCUMEMSM-AF-04 <br />