2005-05-31_REPORT - M1989030

• Permit No: M1989030
• IBM Index Class Name: Report
• Doc Date: 5/31/2005
• Doc Name: Annual Fee/Report Notice
• From: san miguel county
• To: dmg
• Media Type: D
• Archive: No

~ RECEQYE~D
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
San Miguel County
M-1989-030
Zadra Pit
May 15, 2005

MAY 3 i 2005
iJf~icic;, of @4i,.,.r,.la ~~ ftrolc~y
$688.00 (Due on or before your anniversary date)
San Miguel
~'
---According-to-C-.R.S-34-32-5=1.16-or_G.R.S.-34-32-1-16,_each_year,-on the anniversa_ry_date of the_permit, an _ __
operator shall submit the annual fee, a report and map showing the extent of current disturbances to_affected t_
-- - - land,,-reclamatiou-accomplished to d"ate an'd during the preceding yyear, 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 ynnr revised written annual reRnrt and annnal repnr 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: Mike Homer
Permittee Name: San Miguel County
Address: P.O. Box 426
Norwood, CO 81423
Ehone.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/~ orate~~wner, or Designee
s~~ /o,r
Dam
M:~PERMITMASTERDOCl3MENTSV,I-AF-04