2006-01-13_REPORT - M1981158

• Permit No: M1981158
• IBM Index Class Name: Report
• Doc Date: 1/13/2006
• Doc Name: Annual Fee/Report/Map
• From: Forest Lakes Metro District
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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RECEIVED
JAN 1 3 2006
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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Forest Lakes Metro District
M-1981-158 /
Forest Lakes Pit #1
January 26, 2006
$281.00 {Due on or before your anniversary date)
La Plata
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-submit the annual fee,-a report-and-map-showing the extent of currenfdistuibanoes io 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 attach ym~r revised written annnal re:nnrt and annual repprt main 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 pennittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Dale Kortz
Permittee Name: Forest Lakes Metro District
Address: P.O. Box 440
Bayfield, CO 81122-0440
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. /1
ttAM
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Date
or Designee
M:~PERMITMASTERD000MENTSUI-AF-04