2003-07-14_REPORT - M1997035

• Permit No: M1997035
• IBM Index Class Name: Report
• Doc Date: 7/14/2003
• Doc Name: Annual Fee Payment/Report
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Park County
M-1997-035
Chaparral2
July 21, 2003
RECESVEQ
JUL 14 2003
Division ~f Minerals and Geology
$281.00 (Due on or before your anniversary date)
Park
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
operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected
land, reclamation accomplished to date and during the preceding"year, new disturbances that are anticipated to
occur during the upcoming year, reclamation [hat will be performed during the coming year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written annual reDnrt and annual rP,Pnrt main to this form- Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes: p II //
Permittee Contact: Doug Keith 1n/7ob2r ~. UQY1C2
Permittee Name: Park County 't'py ~~ 1 >>un ~~
Address: P.O. Box 147 OO pia Y /y 7
Fairplay, co Soaao ~/I r~r.~ln.u Cn Sl3 yy~
---Pttone Number-- [phone] - - - - ~77 4~ -~~~--~ "`7~0 -
Fax Number: [phone] C 719) 83fo - ~! a 7,5
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
$~
Si tore of Corporate Officer, Owner, or Designee
_~ ~, //, ~U03
Date ~
M~IPERMIT1MASiERDOCUMENTSVN-AF-04