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~k~~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Park County <br />M-1986-140 <br />Wright Pit <br />April 13, 2004 <br />RECEIVED <br />MAR 3 0 2004 <br />Divisic.~ ci Aflirerets & Geology <br />$281.00 (Due on or before your anniversary date) <br />Park <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written anmral rennrt and anneal report m ~n to this form. P['¢aS¢ 710t¢ that ari <br />adequately labeled map [hat clearly deldneates and includes the above elements may suffice for a wrdt[en report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Robert Vance <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />(71q~ ~s3t,- 42zS <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 enclosed. <br />~~ Vim--- ~ <br />Signature of Corporate Officer, Owner, or Designee <br />Park County <br />P. O. Box 147 <br />Fairplay, CO 80440 <br />(719)836-4282 <br />~Zq/ a~ <br />Date ~`~ <br />