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- ,~ <br />~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANN]VERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />t/ ANNUAL FEE and REPORT REQUEST <br />v ontrose County <br />r/ M-1983-148 <br />Neal Pit <br />January 30, 2007 <br />$$688.00 (Due on or before your anniversary date) <br />Montrose <br />nn'z92 <br />-/5~0~ <br />RECEIVE <br />1/Diws~,: ,, .tec .nation, <br />Mininy and aa~aty <br />`~,IAtJ ~ 5 2007 <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, 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 aze anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming yeaz, 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 resort and annual resort map to this form. The Annual <br />Report Br 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 durinc the previous vear and no <br />new chances to the arevious year's map are necessary. then no new maa is required, arovided 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 since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Brian Wilson <br />Permittee Name: Montrose County <br />Address: 161 S. Townsend <br />Montrose, CO 81401 <br />Phone Number: (970) 252-7000 <br />Fax Number: (970) 252-7010 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it this form along with your written report and map. Annual Report instructions aze <br />igna e of Corporate Officer, Owner, or Designee <br />Date <br />M ~PERMII~MASTERDOCIJMEMSVM-AF-04 <br />