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6 ~'" <br />RECEAVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Custer Couuty <br />M-1995-026 <br />Gravel Pit M-093 <br />August 24, 2002 <br />AUG 0 8, 2002 <br />Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Custer <br />According to C.R.S. 34-32.5-I16 or C.R.S. 34-32-116, eacfi year, on the anniversary date of the permit, an <br />__ __ .operator shall submit the annual-fee, a report and map showier 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 [he 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 your revised written annual report and annual report maa 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: Gary L. Havens <br />Permittee Name: Custer County <br />Address: P.O. Box 1669 <br /> Westcliffe, CO 8]252 <br />-Phone Number: _ - -(919) 783-2281__ _ _ _ __ _ _ _ . _ - --- - - - - - - -- ---- <br />Fax Number: (719) 783-0391 <br />If you have additional comments and/or information that should be provided to the Division, please provide i[ <br />below or attach it to [his form along with your written report and map. Annual Report instructions are <br />enclosed. <br />~~ <br />Signature of Co rate Officer or Owner <br />`~~ S- n~ <br />Date <br />M iPERMITVNAS'rER DOC UMENTSVvI-AF-OS <br />