2003-10-14_REPORT - M1978065

• Permit No: M1978065
• IBM Index Class Name: Report
• Doc Date: 10/14/2003
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Rio Grande County
M-1978-065
Seven Mile Plaza
October 22, 2003
OCT 1 4 2903
Division of Pninerals and Gealapy
$281.00 (Due on or before your anniversary date)
Rio Grande
- -According-to C:R.S.-3432.-5-116-or C.R.S. 34-32-116, each year,-on-the-anniversary-date of_the-permit,-an---
operator shall submit the annual fee, a report and map 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 active operations ceased for the year, if any.
Please attachwmn• revised written annnal report and annual rennrt m ~n 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: Lawrence "Buddy" Shaver
Permittee Name:
Address:
Rio Grande County
168 N. Washington
Monte Vista, CO 81144
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.
ASSISTANT ROAD SUPERVISOR
Srgnature of Corporate Of tcer, Owner, or Designee
OCTOBER 10,2003
Dale
M9PERM INIASTERDOCUMENTSVN-AF-04