2007-05-09_REPORT - M1983001

• Permit No: M1983001
• IBM Index Class Name: Report
• Doc Date: 5/9/2007
• Doc Name: Annual Fee/Report/Map
• From: Washington County
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMTI'TEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
~ I~ /
ANNUAL FEE and REPORT REQUEST
~ }'Vashington County
M-1983-001
Cecil 11-34-49
May 16, 2007
$$281.00 (Due on or before your anniversary date)
Washington

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Div' - _. pion,
im~cin, snd Sai,:iy
- - --According-to-C.RS 34=32,5=1-16_or~.R.Sr34-32,.11b,_each_yeaxron_the_anniversary_date_of the-pexmit,_art_ _ _
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 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 vour revised written annual report and annuat report mau to this form. The Annual
Report & Fee requirement is not met until we Gave received the following components: fee, report, and
associated map. If no new disturbances or reclamation have occurred durinc the previous vear and no
new chances to the previous year's map are necessary. then no new map is required, provided that the
Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly
delineates and includes the above elements may suffice for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Larry Champ
Permittee Name: Washington County
Address: P.O. Box 32
Anton, CO 80801
Phone Number:
Fax Number:
[phone]
[phone]

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.
~Q,c,~-y (~tQ~ ~
~gna{ure orporate fficer, Owner, or Designee
~- 7 D7
Date
M:~PERMITIMASTERDOCUMENTSU.I-AF-04