2007-05-16_REPORT - M1985040

• Permit No: M1985040
• IBM Index Class Name: Report
• Doc Date: 5/16/2007
• Doc Name: Annual Fee/Report/Map
• From: Seifert Construction
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REQUEST
Seifert Construction
~ivl-l9ss-oao
Seifert Pit
June 18, 2007
$$688.00 (Due on or before your anniversary date)
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Din'=`c, :f . F,.. - §7i;
According to C.R.S. 34-32.5-I 16 or C.R.S. 34-32-116, each year, on the anniversary date of th_e permit, an operator ~_
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_ -_ --- shall-submit-the annual fee; aizport 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 attach vour revised written annual report and annual resort mao to this form. The Annual Report
& Fee requirement is not met until we have received the following components: fee, report, and associated
man. If no new disturbances or reclamation have occurred during the previous veer and no new chances to
the previous year's mao 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: Mary Seifert
Permittee Name: Seifert Construction
Address: CF.PR.address 1
P-.O. Box 305 -
Westcliffe, CO 81252-0305
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.
Signature of orpora e Officer, caner, or Designee
~l~fn`7
Date