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• ; • • III III'll�ll"IIIII <br /> I <br /> ANNUAL FEE and REPORT REOUEST <br /> PERMITTEE NAME: Park County DECEIVED <br /> PERMIT NO.: M-1980-252 MAR 2 0 2001 <br /> Division of Minerals and Geology <br /> OPERATION NAME:Jefferson Flat Pit <br /> ANNIVERSARY DATE: April 1,2001 <br /> ANNUAL FEE: $688.00 (Due on or before anniversary date) <br /> COUNTY: Park <br /> According to C.R.S. 34-32.5 or C.R.S. 34-32-116, each year. On the anniversary date of <br /> the permit, an operator shall submit the annual fee, a report and map showing the extent <br /> of current disturbances to affected land, reclamation accomplished to date and during the <br /> preceding year, new disturbances that are anticipated to occur during the upcoming year, <br /> the dates for the beginning of active operations, and the date active operations ceased for <br /> the year, if any. <br /> Please attach your revised written annual report and annual report map to this <br /> form.Please note that an adequately labeled map that clearly delineates and includes <br /> the above elements may suffice for a written report. <br /> Division records indicate the following pennittee contact info tion. Please verify and <br /> make any necessary changes: � Co , —71 q -816 . 1771 <br /> Pemtittee Contact: DU ll�E ITl+ <br /> Permittee Name: 4--%R-4 <2nuAdTt4 <br /> Address: , -6 cA I <br /> Ai R►PL4 . C D., 8 044 0 <br /> Phone Number: -71 q 3 �1270 <br /> Fax Number: 71 6310- 275 <br /> If you have additional comments and/or information that should be provided to the <br /> Division,please provide it below or attach it to this form along with your written report <br /> and map. Annual Report instructions are enclosed. <br /> Signature of Corporate Officer or Owner <br /> Date <br /> \ I <br />