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( ~ D" <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Park County <br />RECEIVED <br />MAR 2 8 2002 <br />PERMIT NO.: M-1980-014 <br />OPERATION NAME: Eleven Mile Pit <br />ANNIVERSARY DATE: April 1, 2002 <br />Division of Minerals and Geology <br />ANNUAL FEE: $688.00 (Due on or before anniversary date) <br />COUNTY: Park <br />According to C.R.S. 34-32.5 or C.R.S. 34-32-116, each year. On the anniversazy date of <br />the permit, an operator shall submit the annual fee, a report and map showing the extent <br />of current disturbances to affected land, reclamation accomplished to date and during the <br />preceding year, new disturbances that aze anticipated to occur during the upcoming yeaz, <br />the dates for the beginning of active operations, and the date active operations ceased for <br />the yeaz, if any. <br />Please attach your revised written annual report and annual rebort map to this <br />form. Please note that an adequately labeled map that clearly delineates and includes <br />the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and <br />make any necessazy changes: <br />Permittee Contact: <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Doug Keith <br />Pazk Countv <br />P.O. Box 147 <br />Fairolav, CO.,_,80440 <br />719 836-4270 <br />(719L836-4275 <br />If you have additional comments and/or information that should be provided to the <br />Division, please provide it below or attach it to this form along with your written report <br />and map. Annu~~ ipstructions are enclosed ON~CMK ~k C01NMr <br />Officer or Owner <br />Date <br />