REP37821

• Permit No: M1980014
• IBM Index Class Name: Report
• Doc Date: 4/9/2003
• Doc Name: Annual Report
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Park County
M-1980-014
Eleven Mile Pit
April 1, 2003
RECEIVED
APR 0 9 2003
Division of Minerals and Geolu~Y
$688.00 (Due on or before your anniversary date)
Park
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
- - operator-shall-submit the annual-fee, areport-and .map-showing_the_extent of current_disturbances to_affected
land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to
occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Pfease attach xpnr revised written anm~al report and anmral report niaP to thfs form- Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffrce for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Robert Vance ~pl'C~ ~~ 1't'1-}
Permittee Name
Address:
Park County
P.O. Box 147
Fairplay, CO 80440
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
~~'~ "'"~
Officer, Owner, or Designee
Date
M:~PERMITM ASTERDOCUMENTSUA-AF-04