2006-03-09_REPORT - M1989004

• Permit No: M1989004
• IBM Index Class Name: Report
• Doc Date: 3/9/2006
• Doc Name: Annual Fee/Report/Map
• From: Kit Carson County
• To: DMG
• 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:
vANNTJAT, FEF. and REPORT RF.nTJF.ST
v Kit Carson County
/ M-1989-004
Raymond Duell Pit
April 26, 2006
v ~PR~`J ~~~oy
~~65
otM
$688.00 (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
------opera±o~shall-sib. ' '" ~ f , aa~epo~tandavap-showing * P extent-ofcurrent.disturbance~to,~ected - -
land, reclamation accomplished to date and during the preceding year, new disturbances 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 b~nur revised written anmial report and annual report m~ to 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 BrownSeld
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 it to t form along with your written report and map. Annual Report instructions are
enclosed. _
~~~C~'~%r~i ~'c~
Owner, or Designee
Date
D
M:~PERMITMASTERDOCUMEMSVvI-AF-04