REP24606

• Permit No: M1989004
• IBM Index Class Name: Report
• Doc Date: 4/12/2007
• Doc Name: Annual Rpt
• From: Kit Carson County
• To: DRMS
• Permit Index Doc Type: Annual Reclamation Report
• Media Type: D
• Archive: No

ANNUAL FEE an ~ PORT UEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
'Kit Carson County
/1~I-1989-004
Raymond Duell Pit
Apri126, 2007
v.;. •.
F"'~ 1 ?_1_i~~7
fa~in!n~ un~ Sal~iy
$$281.00 (Due on or before your anniversary date)
Kit Carson
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 current disturbances to affected
._ -1and,_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 vour revised written annual report and annual report map to this form. The Annual
Report & Fee requirement is not met until we have received the following components: fee, report, and
associated map. If no new disturbances or reclamation have occurred durin¢ the previous veer and no
new changes to the previous year's map are necessary, then no new map is required, provided that the
Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly
delineates and includes the above elements may since for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Lyn-Brewnficld ~~tl~ '~ ~-f~~
Permittee Name:
Address:
Kit Carson County
P.O. Box 160
Burlington, CO 80807
Phone Number: [phone]
Fax Number: [phone]
A t~h~-~ka3 A ~~.,1?a
a-P GY,n. u Q t tfh_2 •n ~ . Q Q.t r'~
If you have additional comments and/or information that should be provided to the Division, please provide it
below or ~ach it to this form algpg wfQt your written report and map. Annual Report instructions are
of Corporate Officer, Owner, or Designee
~ .~-y-o ~
Date ~
^~~ I~ M:,PERMI'M4ASTERDOCUMEMSNI-AF-04