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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Colorado City Metropolitan District <br />M-1979-158 <br />Mountain Shadows Pit <br />December 20, 2003 <br />$688.00 (Due on or before your anniversary date) <br />Pueblo <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 anneal repnrt~and anneal rep_nrt map 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 />Pemuttee Contact: Frank Main _ <br />Pernuttee Name: Colorado City Metropolitan District <br />Address: 4497 Bent Brothers Blvd <br />P. O. Box 19390 . <br />Colorado Springs, CO 81019 ~p`~(~'(Jd ~~y Cd ~Voq~ <br />Phone Number: (719) 676-3396 - - <br />Fax Number: (719) 676-3172 <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 />~,1 ~~G~BilE® <br />_- ~~. <br />Si a re of Corporate O~'ficer, Owner, or Designee DEC' ~ 2~ <br />~~- q-o3 <br />Date r:..; =ien sS P^insnls and G2nfa~g <br />M:IPERMIT WIASTERDOCUMENTS Wi-AF-04 <br />