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'CT <br />PERMI'I"I'EE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Elbert County <br />M-2001-010 <br />Allison Gravel Pit <br />August 14, 2002 <br />$688.00 (Due on or before your anniversary date) <br />Elbert <br />FiECElVED <br />AUG 1 32002 <br />Division of Minerals and Geology <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 perntit, 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 Your revised written annual report and annual report map to this form. Please note zhat an <br />adequately labeled map that clearly delineates and includes the above elements may suffice 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: Tim Sheridan <br />Permittee Name: Elbert County <br />Address: 809 Ute Ave. <br />Simla, CO 80835 <br />Phone Number: (719) 541-2268 <br />Fax Number: (719) 541-2826 <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 [his form along with your written report and map. Annual Report instructions are <br />enclosed. <br />ignature of Co e teu~0 cer or Owner <br />--t-r-, ~ ~GU,~. <br />Dale 1 <br />M:~PERMITMASTERDOCUMENTSVv1-AE-04 <br />