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J ._ <br />~` ~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Lake County <br />"lvi-1977-459 <br />Lake County Grav Pit <br />July 8,2007 <br />R,~C~~VED <br />~,~~N r 81po~ <br />~a; ~~ ^'~a7~- <br />tining ynd S~tAN,, <br />$$688.00 (Due on or before your anniversary date) <br />Lake <br />"-According-to'C:R:S.-34-321-16-o~GRS.-34,32L16,_ea h ear on the anniversary date of the permit, an <br />- _ operator_shalLsulunil_the_annual~ee,_a_cepoct and. map showing-the-extent.of-current-distur antes-to affected- <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during 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 your revised written annual report and annual report map to this form. The Annual <br />Report & Fee requirement is not met until we have received the fallowing components: fee, report, and <br />associated man. If no new disturbances or reclamation have occurred during the previous year and no <br />new chances to the previous year's map are necessary, then no new map is required, provided that the <br />Operator shall state this in the Annual Reoortshall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may suff ce for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Brad Palmer <br />Permittee Name: Lake County <br />Address: Road and Bridge <br />P,O. Box 964 <br />Leadville, CO 80461 <br />Phone Number: (719) 486-0259 <br />Fax Number: (719) 486-8479 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it tot rm along with your writt report and map. Annual Repor[ instructions are <br />enclosed. <br />Signature of Corporate O ficer, Owner, or Designee <br />~~~ -V <br />Date <br />M:NERMIINIASTERD000MENTSNd-AF-04 <br />