Laserfiche WebLink
~~D <br />~' ANNUAL FEE and REPORT REQUEST ~ <br />// <br />PERMffTEE NAME: ;, Saguache County <br />r^t ~~ ._... _._ .. -~ <br />PERMIT NO.: V M-1977-567 V'°.. , <br />OPERATION NAME: Airport Pit ; .; ~ <br />ANNIVERSARY DATE: November 25, 2006 C: ~ bn ~ ~ ~,i. <br />ANNUAL FEE DUE: $281.00 (Due on or before your anriiv rsary date) <br />COUNTY: Saguache <br />~~Z <br />According to C:R:S-34=32:5-116 or C:R:S-34=32-II6, each-yeaz;-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 during the previous veer and no <br />new chanties to the previous year's man 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 suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: n r / / / / <br />Permittee Contact: John T. Ungefug ICcr4J.,o/ f~ ~rrcc-ION~J~ ~ <br />Permittee Name: Saguache County //~~ <br />Address: P.O. Box 655 Y'~g 9)~ <br />Saguache, CO 81149 <br />Phone Number: (719) 655-2554 <br />Fax Number: (719) 655-2543 <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 Corporate Officer, Owner, or Designee <br />UNIT / FUNC ~ ~~3 <br />//-~, ~~ APPROVAL ____ <br />Date <br />M:IPERMITNIASTERDOCUMENTS~M-AF-04 <br />