Laserfiche WebLink
• iii-iiiiiiiiniuiii • <br /> 999 <br /> ANNUAL FEE and REPORT REQUEST <br /> PERIV=EE NAME: Logan County RECE►V ED <br /> PERK:IT NO.: -17?- /978 -l w(n SEP 14 2001 <br /> OPERATION NAME: Stephens Ptf Division <br /> ofMineralsand <br /> ANNIVERSARY DATE: Or rob2r' l Geology <br /> ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br /> COUTITY: 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 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, if any. <br /> Please attach your revised written annual report and annual report map to this form. Please note that an <br /> adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br /> repor,'. <br /> Division records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: <br /> Permittee Contact: Ken Strohson <br /> Pem»ttee Name: -I.eganpounty drD6 0'4, l�f <br /> Addr(:ss: 315 Main St. <br /> Sterling, CO 80751 <br /> Phon: Number: {3B3}533=�$34 9 O Saa- 7 P79 <br /> Fax Number: 97o SoZol - `fO 1 S" <br /> If you have additional comments and/or information that should be provided to the Division, please provide it <br /> belov, 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 /> Date <br /> M:TER?4MMASTERDOCUMENrSIM AFOA <br />