Laserfiche WebLink
ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Jack Pine Mining Company <br />M-1990-147 <br />Mendota Properties <br />February 12,2007 <br />$$225.00 (Due on or before your anniversary date) <br />Clear Creek <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,, ieclatnation accomplished to date and during ttie preceding year, new8i"sturbances thafare 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 vour revised written annual reuort and annual report man to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the urevious vear and no <br />new changes to the previous year's man are necessary. then no new man is required, provided that the <br />Ouerator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may suffice jor a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Fabyan Watrous <br />Permittee Name: Jack Pine Mining Company <br />Address: P.O. Box 66 <br />Idaho Springs, CO 80452-0066 <br />Phone Number: (303) 567-2350 <br />Fax Number: <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 />1 ~/~~ ~~~~ ~,y <br />Signature of 6(irporate Officer, @waet; or <br />/a -a~' <br />Date <br />/'~' L~G - - ~/ <br />~70P`, <br />M:~PERMI'INIASTERDOCUMEN'1'S/A1-AF-02.DOC <br />