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999 <br /> ANNUAL FEE and REPORT REOUEST �C�ivGD <br /> PERMITTEE NAME: Dewitt Excavating N C- <br /> PERMITNO.: M-1983-132 ,VL `a`SaedG- <br /> OPERATION NAME: Dewitt Excavating ( �� C �IV`SenetM�ae <br /> ANNIVERSARY DATE: July 29,2001 <br /> ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br /> COUNTY: Prowers <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 your revised written annual report and annual report 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 /> Permittee Contact: Terry Dewitt_ t� <br /> ermit[ee Name: Dewitt Excavating`-� <br /> Address: 7395 U.S. Hwy. 50 W. �o / <br /> Lamar,CO 81052 (7 A . <br /> Phone Number: (719) 336-4455 C) tL <br /> Fax Number: (719) 336-8150 <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 /> S <br /> Si gt attire of Cor Irate Officer or Ow er <br /> � I��F-� � <br /> Date <br /> M APERMITMASTERDOCUMENTSW-AF 01 <br />