2006-08-10_REPORT - M1982094

• Permit No: M1982094
• IBM Index Class Name: Report
• Doc Date: 8/10/2006
• Doc Name: Annual Fee/Report/Map
• 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.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
l/ ANNT1Ai. FF.F, and RF,PnRT RF./1TTF.ST
~ Kit Carson County
`/M-1982-094
Kit Carson Couuty o7
Juue 24, 2006
R~CE~VED
v'4UG 10 2006
~rt'ision otReGamation,
Mining antl Safety
$281.00 (Due on or before your anniversary date)
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 [haYare anticipated to
occur during the upcoming year, reclamafion 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~rr revised written annual report and annual report maRfn 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:
Permittee Name:
Address:
Lyn Brownfield
Kit Carson County
P.O. Box 160
Burlington, CO 80807
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 i~ this form along with your written report and map. Annual Report instructions are
Officer, Owner, or Designee
Date
M:~PERMITMASTERDOCUMENTSNI-AF-04