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~6 ~~- <br />ANNUAL FEE and REPORT REQUEST <br />~~~~ <br />PERMITTEE NAME: ~ Town of Limon i ' <br />PERMITNO.: ~-1998-103 ~ ~~t~i ~ +~~~ <br />OPERATION NAME: Patty's Pit ~M/~~~' ^"' ~~~~~ <br />ANNIVERSARY DATE: April 10, 2007 ~`" -c~~ ~9. <br />ANNUAL FEE DUE: $$281.00 (Due on or before your anniversary date) <br />COUNTY: Elbert <br />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 <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, ieclamation accomplished"to date and-during-the preceding year, new disturbances that-are-anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report moo to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated man. If no new disturbances or reclamation have occurred durine the previous veer and no <br />new_ chances to the~revious year's map are necessary. then no new maa is required, urovided that the <br />Operator 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 />Permittee Contact: Dave Stone <br />Permittee Name: Town of Limon <br />Address: P.O. Box 4 <br />Limon, CO 80828 <br />Phone Number: (719) 755-2346 <br />Fax Number: 719- 77.5.9073 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />~~ <br />Signature of Corporate Officer, Owner, or Designee <br />3/i~ to ~ <br />Date <br />M:~PERMITMASTERD000MENTS~.M-AF-04 <br />