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RECEIVED <br />~\\l 11 1'F'1''+nrl a)'1'OR'1' RFUI'Fal <br />FEB 1320(13 <br />Pl.a~nrrrrr. N:~~1E.: <br />Pe.a!~n r Nu.: <br />(ml:an'ru)ti Nn~11:: <br />:\NNIVI'aSn1Z1' DATk:: <br />nNNU.4L FF.k: DUF.: <br />COUNTY: <br />Joseph L. and Arlenc Cohan •~~;i„n of Mmeralr. and Geolopt <br />~t-1 vex-o+~ 1 <br />nrnnld c:nten <br />hcbruar~ 19. 21101 <br />~2121.U11(Uuc on or before your anni+ersur~ date) <br />Chaffee <br />Acconlin~ t.. ('.R.C t4-''+2.5-116 or i .a.~. ~ t-+_'-I I t+. each year. un the annn'ersarv date of the permit, an opernur <br />shall subnut the annual fee, a report and utap siwwmg the extent of current dtsturbanccs to at7cwa-d land. <br />reclamation accomplished to date and during the preceding year, nets dislurhances that are anucipateJ to cxcur <br />during the upcoming year, reclamauon th,d will hr pertbrmcd dune, the a~mmg prtr. the d;ucs li+r the beginning <br />ol'acuve .+perrLons, and the dtue acme ~tpcnnit,ns cca,cd free rite year, ii um <br />~. +tt+th ~n~r rul.r l written an~n++~nnrt an t nny, nit reinter m"n to this fnrn+_ PIt'[LSt' nolB rhrH un <br />~+tliquul<'h Idhilrtl tnup !ltttl rlim'Ir rlCltninlis treat utt'ludis !h+' uhrn'i + h otc rah non eit/ftc < 1,r a x•ri!!en rt/xirr. <br />Uivuum recants indicate the titllowing pcmuttee iuntact inturntation. Please verify and matte any ntcessary <br />changes: <br />Pcrmrttce Contact: Joseph L. Cogan <br />Permittcc Nantc: Joseph L. and Arlenc Cogan <br />Address: "-'~~~'y~~- <br />k'.(). 13tix I I 1 <br />Nathrop.C'O ~l'_36 <br />Phone Numlxr: 171y) 395-''_3?`t - - <br />Fax Number: <br />If you have adduional comments and.'or intixmauun that should be provided to the l7ivisiun. please provide it <br />below or attach it to this form along with your wnttcn report and ntap. Annual deport instructions arc enchyec!- <br />E ~ ~t 4~ <br />Signaturdof Corpora~ficer. Owner, or Designee ~ _~_ _ n , ' ~"~ <br />,~.~.~ ~ ti <br />Date :'r , <br />r~-~~,~~,. , , <br />M-rFNAItr ~IA2tiFRt%t('ltNF7: r~M•N-0I ~' 1 ~.~d.+w'~ <br />