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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNiiAi, FF.F. and REPORT RF.QiiRREt7ECE~~E® <br />MAR 17 2pp3 <br />lliuision of Minerals and Geology <br />Colorado Marble, L.L.C. <br />M-1987-028 <br />Lily Mines <br />March 18, 2003 <br />$281.00 (Due on or before your anniversary date) <br />Chaffee <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach xpyr revised written annual rennrt and anneal rennrf m ~n to this form. Please note that a» <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Bill Tezak <br />Permittee Name: Colorado Marble, L.L.C. <br />Address: 270 S. ISth St. <br />Canon City, CO 81212 <br />Phone Number: (770) 607-3345 <br />Fax Number: (770) 607-3346 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instmctions are enclosed. <br />C ~ ~r- <br />Si afore of Corporate Officer, Owner, or Designee <br />3-0'~-03 <br />Date <br />MAPERMITN1ASTERDOCUMEMSUI-AF-01 <br />~~ Q(~-j~~ ~ ~x~tNSi+a <br />Aer-~'orrntd - SloPi`v~. <br />lYe c]4mA.hci3 <br /> <br />