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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />t/ ANNUAi, FFF, and RF.PnRT RF.OiiF.ST <br />~/ Park County <br />/M-1986-140 <br />Wright Pit <br />Apri113, 2006 <br />bm(c, <br />IS~l~r~t~~~.l <br />~ rti~ ~ ~ ~ 006 <br />V Divioion of Nincrals and Gcolory <br />$281.00 (Due on or before your anniversary date) <br />Park <br /> <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected ]and, <br />-- reclamation accomplished-to date anfl~during the preceding year; new 8isturbarices that`are anticipated-fo occur - <br />during the upcoming yeaz, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach ys~r revised written anm~al report and anneal report map~n this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: / <br />Permittee Contact: David Kintz ~ ~ ~~ L ~°~N ~~ <br />Permittee Name: Park County <br />Address: P.O. Box 147 <br />Fairplay, CO 80440 <br />Phone Number: (719) 836-483' ~Z 8~ t/ <br />Fax Number: (719) 836-4275 <br />If 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 enclosed. <br />/ ~ <br />Signatu o C ~porate,Officer, Owner, or Designee <br />3//~w~ <br />Date <br />