2004-06-10_REPORT - M1995023

• Permit No: M1995023
• IBM Index Class Name: Report
• Doc Date: 6/10/2004
• Doc Name: Annual Fee/Report/Map
• From: Corkle Construction
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
~- v
Corkle Construction RECEIVED
M-1995-023 JUN 10 2004
Peterson Pit
Diaiaion of Minarala b Daolopy
June 8, 2004
$281.00 (Due on or before your anniversary date)
Jackson
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
shall~ubmit_the_ann_ual fee, a report and man showing the extent_of current disturbances to affected land,
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date acfive operations ceased for the year, if any.
Please attach ym~r revised written anneal report and anneal re nn rt man to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Harry E. Corkle
Permittee Name: Corkle Construction
Address: Box 306
Walden, CO 80480
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
Signatur--~at~ f~Owner, or Designee
Date