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02-AUG-2005 13:55 FRO1lrColarado Division of ilinerals 6 Geology +13036326106 <br />Kit Carson County~""~ <br />/f~I-1982-094 <br />/~,v,v~~~ R ~ T <br />PERMiTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />AI~INIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Kit Carson County <br />June 24, 2005 <br />T-221 P.004/0016__ F-515 <br />o~ IL <br />-:~ <br />~~~~ 2 5 ?D05 <br />~JDiiisiar, r. <br />dnolopY <br />$281.00 (Due on or before your anniversary date) <br />Kit Carson <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 yeaz, new distwbances that aze anticipated to <br />occw dwing 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 ~Lrpyiaed written anneal re~tnrt and anneal re~Qrt m~~,fn i6ia form. Please Hole fha! an <br />adegua[ely labeled map that clearly delineates and includes [he above elemen[s may suffrce for a written <br />report. <br />Division records indicate the following permittee contact information. Please verity and make any necessary <br />changes: <br />Pefmittee Contact: <br />Permittee Name: <br />Address: <br />Lyrowniield <br />Kit Carson County <br />P.O. Box 160 <br />Bwlington, CO 80807 <br />LVN <br />Phone Number: (719) 34&~ br-=(J <br />Fax Number (719) 346-7242 <br />If you have additional co eats and/or information that should be provided to the Division, please provide it <br />below or attach it ss form alottg with yow written repon and map. Annual Report instructions are <br />Signature <br />or <br />U <br />