2006-06-28_REPORT - M1997035

• Permit No: M1997035
• IBM Index Class Name: Report
• Doc Date: 6/28/2006
• Doc Name: Annual Fee/Report/Map
• From: Park County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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ANNiiA1. FF.F, and RF.PnRT RF,~iTF.ST
PERMITTEE NAME:
PERMTI' NO.:
OPERATION NAME:
ANNPJERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
°~ ark County
l~M-1997-035
Chaparral 2
July 21, 2006
I~EC~'l~,lE®
~~~JUN28 20~
r' Division of Minerals and Geology
$281.00 (Due on or before your anniversary date)
Park
w~" it
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, reciamafion aocom`plishe~"to dalee and'duiing the preceding year, new disturbances tfiat aTe anticipate~lc to
occur during the upcoming year, reclamation that 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 anmral rennrt and snnnal ~. on rt maT to Chic 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: -~;
Permittee Contact: Jim Linn r) ~, ~'~, { 1 "n
Permittee Name: Park County '~!~ 12!
Address: P.O. Box 147 ~© ~Jp~( 1 g-7
Fairplay, CO 80440
Phone Number: [phone]
Fax Number: [phone]
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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.
Signature of Corporate Officer, Owner, or Designee
Date
M:~PERMITMASTERDOCUMENTSUI-AF-04