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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />bl,~~~ <br />~/ ANNUAi. FF,F, and RF.PnRT RF,QiTFST <br />,/ Fremont County <br />v' M-1986-010 <br />Cottonwood Pit <br />January 20, 2006 <br />RF~~a~R® <br />,i ;/ FEB ~ 3 2~pg <br />Division of lyinerats and boo%BY <br />$688.00 (Due on or before your anniversary date) <br />Fremont <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 showing 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 the year, if any. <br />Please attach ynnr revised written annual report and annual re on rt m yn to this form- Please note that an <br />adequately labeled map 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: Curtis Stone <br />Permittee Name: Fremont County <br />Address: Fremont County Commissioners <br />615 Macon Ave., Room #105 <br />Canon CIty, CO 81212 <br />Phone Number: (719) 276-7320 <br />Fax Number: (719) 275-7626 <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. Annua] Report instructions are <br />enclosed. <br />Signatur~at~cer, Owner, or Designee <br />Dale <br />M:~PERMIr1MASTERDOCUMEM5UI-AF-04 <br />