2006-05-01_REPORT - M1988032

• Permit No: M1988032
• IBM Index Class Name: Report
• Doc Date: 5/1/2006
• Doc Name: Annual Fee/Report/Map
• From: Washington County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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RECEIVED
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Washington County
~;M-1988-032
Fassler Gravel Pit
May 18, 2006
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Olvialon of Minareq and Oeolo®Y
$281.00 (Due on or before your anniversary date)
Washington
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According Yo 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, a report and map showing the extent of current disturbances to affected
land, reclamation_accomplished,to_date,and_during.the~receding_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.
Please attach ynnr revised written anmral re~pn and annual re nr~ t man to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Tim Davis
Permittee Name: Washington County
Address: 150 Ash
Phone Number:
Fax Number:
Almon, CO 80720
[phone]
[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.
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Signature of porate Officer, Owner, or Designee
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Date
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