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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: a $~ ~ <br />ANNUAL FEE DUE: <br />COUNTY: <br /> <br />ANNUAL FEE and REPORT REQUEST <br />Jo Aon Vota <br />M-1982-011 <br />Hillyer Pit <br /> <br />RECIEIVED <br />JUN 1 1 2001 <br />Division of Minerals and Geology <br />J ne24,2001 <br />$22.0 (Due on or before your anniversary date} <br />Sao Jua <br />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 <br />operator shall submit the annual fee, a report and map sfiowing 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 [he year, if any. <br />Please attach your revised written annual report and annual report maa to this form. Please note tlrat an <br />adequately labeled rnap that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Joanna Vota <br />Permittee Name: Jo Ann Vota <br />Address: P.O. Box 3142 <br />Durango, CO 81302 <br />Phone Number: (970) 259-1319 <br />Fax Number: <br />nto G{7Curde <br />-_-~ <br />[f 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 />S' azure of Corporate Officer or Owner <br />-O <br />Date <br />M ~PERA11N.1ASTERD000MEMSVv1-AF-01 <br />