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_ '7 <br /> np „. _-, <br /> ANNUAL F and REPORT REQUEST <br /> C/ <br />PERMITTEE NAME: / he Clare Corporation ~" '' <br />PERMIT NO.: ~M-1989-044 <br />OPERATION NAME: Twin Crk Campground <br />ANNIVERSARY DATE: April 10, 2007 <br />ANNUAL FEE DUE: $$281.00 (Due on or before your anniversary date) <br />COUNTY: Teller <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />__ reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, rec amatton t at w~ a per'Tl-fi-""tormed`lltSi'firg'tlle-comingyear, tire-dates-fer-the-beginning <br />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. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new chanties to <br />the previous year's man are necessary. then no new man is repaired. provided that the Ouerator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Harold E. Claze, II <br />Permittee Name: The Clare Corporation <br />Address: P.O. Box 1 <br />Phone Number: <br />Florissant, CO 80816 <br />(719) 748-3805 <br />Fax Number: <br />(719) 748-5120 <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 aze enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />~~~ ~ /o ~ <br />Date ~~ <br />