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bmk <br />AFrRPr <br /> <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Park County <br />~VI-1997-035 <br />Chaparral 2 <br />July 21, 2003 <br />~UG 2 6 2005 <br />-yJ) Divisio. _ ... _ - <br />$281.00 (Due on or before your anniversary date) <br />Park <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, reclamaticn accomplished to date and during the preceding year, new dishsbances that are anr;cipated 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 ymir revised written annual report and annual red ort man to this form- Please note that an <br />adegarately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Doug Keith ~ ~~_x '~h'~'.'4" <br /> <br />Permittee Name: Park County ~dr ~~ ~~xLn ~t <br />Address: P.O. Box 147 OO L"70 X /t-/`7 <br /> <br /> <br /> Fairplay,CO 80440 ~t//JL a.J Cn ~Btltl~ <br /> <br />Phone Number: (719) 836-4270 C71 9 ~ ~53~- ~ a ~r [~ <br />Fax Number: (719) 836-4275 ~ 719 831 - ~! a ~s <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 />Si re of Corporate Officer, Owner, or Designee <br />~'' l % ' ~ z:.5 <br />Date <br /> <br />M9RERM ITMASTERDOC UM ENTSUI-AF-04 <br />