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C <br /> ; <br /> :..� • • III I II I II III IIII III� <br /> ANNUAL FEE and REPORT REOUEST <br /> PERMITTEE NAME: Washington County RECEIVED <br /> PERMIT NO.: M-2000-084 AUG 15 2001 <br /> OPERATION NAME: Chris Aaegeson Pit#2 Division of Minerals and Geology <br /> ANNIVERSARY DATE: August 30,2001 <br /> ANNUAL FEE DUE: $281.00(Due on or before your anniversary date) <br /> COUNTY: Washington <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 your 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: Charles J. Kuntz �fi �y`�/"a�� -7d4.2t I]M,9n/,� / <br /> PermitteeName: Washington County -4 ���t��,t, (�tuL'ti 1 <br /> Address: 150Ash �!_; ���_� 6� <br /> L1.. J kOAA 1.,j/7-jZe) .l <br /> Akron, CO 80720A ��—t+r <br /> l /Z <br /> Phone Number: (970) 246-3347 t L l L ; s <br /> Fax Number: (970) 345-2702 <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 /> Signature of C rporate fficer or Owner <br /> rZ 32Oo/ <br /> Date <br /> M.\PERM rr\MASTERDOCUNI ENTS'Al-AF-a1 <br />