2005-06-14_REPORT - M1982075

• Permit No: M1982075
• IBM Index Class Name: Report
• Doc Date: 6/14/2005
• Doc Name: Annual Fee/Report Notice
• From: alvin mosch patricia mosch
• To: dmg
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Alvin Mosch -Patricia Mosch
M-1982-075 ~J s ~
PhoenixPhoenix Mine "M
June 14, 2005
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$225.00 (Due on or before your anniversary date)
Clear Creek
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_distuxhances 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 xpnr revised written annual rennrt and annual rennrt morn to this form- Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Alvin Mosch
Permittee Name: Alvin Mosch -Patricia Mosch
Address: Box 3236
Idaho Springs, CO 80452
Phone Number: [phone]
Fax Number:
If you have additional comments andlor 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
enc]osed.
c~G:. (ilk// a-1~~
Signature of Corporate fficer, Owner, or Designee
- 9~</S
Date
M:~PERMITMASTERDOCUMENTS(M-AF-02.DOC