Laserfiche WebLink
/"- <br />q~ I ~' <br /> <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Phillips County <br />VVV/M-1990-116 <br />Kennedy Pit <br />October 26, 2006 <br />RECFt1/Ep <br />/SEP 12 2006 <br />ivision of Redamation, <br />65ining artd Safety <br />$281.00 (Due on or before your anniversary date) <br />Phillips <br />__ __ According, to C_R.S. 34-32.5-1"16 or C.R_S. 34-32-116, each year, on_the anniyersary_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 map 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 durinc the previous year and no <br />new chances to the previous year's map are necessary, then no new map is required, provided that the <br />Operator 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 for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Randy Schafer <br />Permittee Name: Phillips County <br />Address: 221 S.Interocean <br />__ I-Iolyoke-C-O-8&734---- <br />Phone Number: <br />Fax Number: <br />(970)854-3778 <br />(970)854-3811 <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 />Signatur f Corpor Officer, Owner, or Designee <br />~-oh . <br />Date <br />M:~PERMITVv1ASTERDOCUMEMSUI-AF-04 <br />