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brvl~- <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />V ANNUAL FEE and REPORT REQUEST <br />Fremont County <br />I/~ M-1979-216 <br />Dist No 2 Gravel Pit <br />January 20, 2007 <br />~'~~~ > >zoo~ <br />Dlalsic = : cir maNOn, <br />Min, .. ,?gafofy <br />$$281.00 {Due on or before your anniversary date) <br />Fremont <br />of-i~~ <br />----According-to-C.R.-S: 34-32-5-1-16-or-C-.R.S.-34-32-1-16,-each year,-on-the-anniversary-date-of-the-permit,=an <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding yeaz, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming yeaz, the dates for the <br />beginning of active operations, and the date active operations ceased for the yeaz, if any. <br />Please attach vour 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 following components: fee, report, and <br />associated maa. If no new disturbances or reclamation have occurred during the arevious vear and no <br />new changes to the previous year's map are necessary, then no new map is required. provided that the <br />Oaerator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information Please verify and make any necessary <br />changes: <br />PermitteeContact: Terry Acton <br />Permittee Name: Fremont County <br />Address: Fremont County Commissioners <br />615 Macon Ave., Room # 105 <br />Canon City, CO 81212 <br />Phone Number: (719) 784-6474 <br />Fax Number: (719) 275-7626 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or a ach it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />v <br />Signature of Co orate Officer, Owner, or Designee <br />Date <br />M:~PERMITMASTERD000MENTSUvf-AF-04 <br />