2001-11-23_REPORT - M1984154

• Permit No: M1984154
• IBM Index Class Name: Report
• Doc Date: 11/23/2001
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

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ANNUAL FEE and REPORT REQUEST
P.OY 7 3 G~Jt
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
City of Lamar
M-1984-154
Well Field Pit
December 10, 2001
RECE~`~ ED
tJivisien of Mincrsls and Geology
$281.00 (Due on or before your anniversary date)
Prowers
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
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 your revised written annual report and annual report map to this form. Please note that art
adegaately laheled map that clearly delineates and includes the above elements may sake far a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Patrick Mason
Permittee Name: City of Lamar
Address: 102 E. Parmen[er St.
Lamar, CO 81052-3239
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 Corporate Officer or Owner
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