REP26908

• Permit No: M1982067
• IBM Index Class Name: Report
• Doc Date: 7/19/2007
• Doc Name: Annual Report
• From: Kit Carson County
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
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ANNUAL FEE and REPORT REQUEST
/Kit Carson County
,~M-1982-067
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OPERATION NAME: Bledsoe Pit Divi
of Rect
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ANNIVERSARY DATE: 'n n
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fon,
June 24, 2007 9 and Safety
ANNUAL FEE DUE: $$281.00 (Due on or before your anniversary date)
COUNTY: Kit Carson

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 renort and annual report man to this form. The Annual
Report & Fee requirement is not met until we have received the following components: fee, renort, and
associated map. If no new disturbances or reclamation have occurred durinti the previous year and no
new chanties to the previous year's man are necessary, then no new man 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: -~
Permittee Name: Kit Carson County
Address: P.O. Box 160
Burlington, CO 80807
Phone Number: [phone]
Fax Number: [phone]
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If you have additional comments and/or information that should be provided to the
below or attach it to this form along with your written report and map. Anm
enclosed.
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Signature of Corporate Offic ,Owner, or Designee
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Date
Division, please provide it
al Report instructions are
M:IPERMITMASTERDOCUMENTS~M-AF-04