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<br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />City of Colorado Springs <br />M-1992-074 <br />Hanna Ranch Pit No. 2 <br />March 12, 2001 <br />$688.00 (Due on or before your anniversary date) <br />EI Paso <br />According to C.R.S. 34-32.5-I 16 or C.R.S. 34-32-I 16, each year, on [he anniversary date of the permit, an <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year,.ifany:,~, . ,. .~ .. __ ~. <br />Please attach vour revised written annual report and annual report map to this form. Please Hole thaean ° ~• <br />adequately labeled mnp [hut clearly de(ineales and includes the above elernenls rnrrv suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Peter Eisele <br />PennitteeName: City of Colorado Springs COIOt'dd0 Springs Ut111t1es <br />Address: 703 e. Las Vegas ST. 703 E. Las Vegas Stneet <br />Colorado Springs, CO 80903-000 <br />Phone Number: (719) 448-4458 (719 ~ 66$-4458 <br />Fax Number. (719) 448-4528 (719) 668-4528 <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 or Owner <br />3 J 9lv/ <br />Date <br />M:~PER M ITN1A STER DllCUMENTSVN-AF-04 <br />