2004-08-13_REPORT - M1977184

• Permit No: M1977184
• IBM Index Class Name: Report
• Doc Date: 8/13/2004
• Doc Name: Annual Fee/Report/Map
• From: City of Fort Collins
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

~~
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
City of Fort Collins
M-1977-184
Timberline Pit
August 15, 2004
/U ~'
RECE6~/ED
AUG 1 3 2004
Division of Minerals and Geology
$688.00 (Due on or before your anniversary date)
Larimer
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
ia~ectarn3tion accomplished ro da~nd-during the prece-Ir mg year,-new distur antes 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 y~r revised written annual re~nrt and annual report main to this form- 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: Mark Sears
Permittee Name: City of Fort Collins
Address: P.O. Box 580
Fort Collins, CO 80522
Phone Number: [phone]
Fax Number:
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.
-~l,~G~~
Sign re of Corporate Officer, Owner, or Designee
Date
MiPERMITNIASTERDOCUMEMSVN-AF-04