2000-01-03_REPORT - M1999069

• Permit No: M1999069
• IBM Index Class Name: Report
• Doc Date: 1/3/2000
• Doc Name: Annual Fee/Report Notice
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REQUEST
Jake Kauffman & Son, Inc.
M-1999-069
Wagner/Kauffman Pit #3
January 5, 2002
t e.. ~,
JANI,;~ ;,
~lY1d~Op ~iMinerals and GsologY
$688.00 (Due on or before your anniversary date)
Lorimer
9,~
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-I 16, 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 daiiog 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 your revised written annual reuort and annual report map to this form. Please note that an
adequately labeler! map that clearly delineates ant! includes the above elements may suffice for a written report.
Division records indicate [he following permittee contact information. Please verify and make any necessary
changes:
Permittee Con[act Mary Kauffman
Permittee Name: Jake Kauffman & Son, Inc.
Address: 808 SCR 9E
Loveland, CO 80537
Phone Number: [phone]
Fax Number: [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.
Signa[t~ e of orpo fficer or Owner
Date
._ .. III IIIIIIIIIIIIIIII
999
M ~PERMITMASTERDOCUMENTSV.I-AF-01