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III !IIlIIlIIIIII III `� <br /> ANNUAL bEL anu ricivn, ,. OUEST <br /> PERMITTEENAME: Glenn Southwick RECEIVED <br /> PERMIT NO.: M-1986-007 MAR 0 5 2001 <br /> OPERATION NAME: Masonville Stone <br /> ANNIVERSARY DATE: March 11,2001 Division of Minerals and Geology <br /> ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br /> COUNTY: Larimer <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 man to this form. Please note thdi an <br /> adequalely 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: Glenn Southwick <br /> Pernittee Name: Glenn Southwick <br /> Address: 220 W. CR 84 <br /> P.O. Box 1 103 <br /> Wellington,CO 80549 <br /> Phone Number: (970) 568-3579 <br /> Fax Number: "t �� $ ��✓�c�— <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 /> jjj— <br /> Signature of Corporate Officer or Owner <br /> 3-1- 01 <br /> Date <br /> M AP E RM I TPMA ST E RDOC U NfE N T S\M-A F-0I <br />