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999 <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Colorado Marble, L.L.C. <br />M-1987-028 <br />Lily Mines <br />March 18, 2001 <br />RECEIVED <br />MAR 2 0 2001 <br /> <br />Oiuisian of Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Chaffee <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of [he 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 dare and dying the preceding fir; iiew'disturban~E~dta~ 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, grid the date act?: ° operations ceased for the ye:,r, if any..;, ,~,,,. ~~•.. ; ;; .,~ . _ . <br />Please attach vour revised written annual re~•^r• •rod annual resort map to this furm. Pl~ac; nn[e [hn! an •• <br />adeyuarely labeled reap that clearly delineates and inckrdes the above elements may s:[ffrce for a written <br />repot[. <br />Division records indicate the following perniittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Bill Tezak <br />Pemiittee Name: Colorado Marble, L.L.C. <br />Address: 270 S. 15th St. <br />Canon Ciry, CO 81212 <br />Phone Number: (770) 607-3345 <br />Fax Number: (770) 607-3346 <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 <br />enclosed. <br />Signature of Corporate Officer or Owner <br />~~pZ~pl <br />Date <br />(., D ~w~ d ,~ tan (~ S e w ~ W S`r' s r~ ~. ~~ i vo ~~ t 2 Ys- / t'/2 l <br />O n ~ ~5 ~' Silo n1a~e~ '~o r~Lr d.e~v. ti I K Z00 ( lt)~ /l~L'w ~YlSrivl~udnP~ <br />\ M.WERhn T\hWSTERDOCUMENTS~ht-AF-01_~ <br />lets {fir PoR{- <br />