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;; <br />Gi'tn /_ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />/ El Paso County <br />t~ M-1980-189 <br />Yoder <br />October 23, 2006 <br />ID ~ ~ I <br /> <br />~~~ ~~~ ~ ?ZdQ~ <br />ip~f,:, ~ „4 ~"~w <br />$281.00 (Due on or before your anniversary date) <br />EI Paso <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, reclamation 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 vour revised written annual report and annual report map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred durinti the previous year and no <br />new chanties to the previous year's map are necessary, then no new map is required, provided 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 pennittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: George P. Sugars <br />Permittee Name; El Paso County <br />Address: 3460 N. Marksheffel Rd. <br />Colorado Springs, CO 80922 <br />Phone Number: (719) 520-6860 <br />Fax Number: (719) 520-6878 <br />CN vclC 1'n c.C~.ui.o i-f ~ <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 />iln n ,..n ~ n /1D i <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />M: W ERhfl'MIASTERDOCUMEMSUI-AF-04 <br />