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_~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Lake County <br />M-1977-459 <br />Lake County Grav Pit <br />July 8, 2002 <br /><,~- <br />RECEIVED <br />AUG 0 6 200Y <br />Division of Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Lake <br />According to C.R.S. 3432.5-116 or C.R.S. 34-32-116, each yeaz, on the anniversary date of the permit, an <br />- operator shall-subtTtit-the-annua6fee,-a-report and map showing the-extent-of-current-disturbances to affected <br />]and, reclamation accomplished to date and during the preceding yeaz, new disturbances that aze 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 year, if any. <br />Please attach vour revised written annual report and annual report map to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Robin Schiro <br />Permittee Name: Lake County <br />Address: P.O. Box 964 <br />Road & Bridge <br />Leadville, CO 80461 <br />s <br />Phone Number: (719) 486- <br />Fax Number: (719) 486~59.37i/S~ <br />If you have additional comments and/or information that should be provided to the Division, please provide i[ <br />below or attach it to this form along with your written report and map. Annual Report instmctions are <br />enclosed. <br />azure of Corporate Officer or Owner <br />7-~' -tJy <br />Date <br />M:~PERMITMASTERD000MENTSN4-AF-04 <br />