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<br />~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Park County <br />M-1980-013 <br />Elkhorn Springs Pit <br />April 1, 2004 <br />$281.00 (Due on or before your anniversary date) <br />Park <br />~~~~-- °~ <br />MAR 3 C ~t;U4 <br />DiYiSion of Minerals & Geology <br />According to C.R.S. 34-32.5-]16.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 ynnr revised written annual rennrt and annnal rennrl maw 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 pennittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Doug Keith ~n4,«-t l~~ ~~ _ <br />Permittee Name: Park County <br />Address: P. O. Box 147 <br /> Fairplay, CO 80440 <br />Phone Number: (719) 836-2771 t'7/91 `a3(~- 4ZBZ. <br />J <br />Fax Number: (719) 836-4275 <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 aze <br />enclosed. <br />~ ~~ <br />Si afore of Corporate Officer, Owner, or Designee <br />3/zG~~~ <br />Date <br />M:~PERMI7IMASTERDOCUMENTS~M-AF-04 <br />