2005-06-27_REPORT - M1984156

• Permit No: M1984156
• IBM Index Class Name: Report
• Doc Date: 6/27/2005
• Doc Name: Annual Fee/Report Notice
• From: grand county
• To: dmg
• Media Type: D
• Archive: No

ANNTiAi. FF,F. an RF.PnRT RF.(~iTF.ST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Grand County
M-1984-156 ~
Grand Cnty No 201 aka Scholl Gravel Pit
May 29, 2005
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$688.00 (Due an or before your anniversary date)
Grand
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-]16, 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 preceding 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 rnnr revised written annnal report and annual re~n~p to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: M C. Branstetter
Permittee Name: Grand County
Address: 467 E. Topaz Ave.
P.O. Box 9
Granby, CO 80446
Phone Number: [phone]
Fax Number: [phone]
Ken Haynes
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 Cot orate Officer, Owner, or Designee
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Dates
M:~PERMITMASTEADOCUMENrsU~]-AF-04