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~ ~ li_ <br />,/ ANNUAL FEE and REPORT REQUEST ~~ <br />~iov o i zoos <br />PERMITTEE NAME: ~ Kit Carson County ivision of ftecla~aaiion, <br />Mining and Safety <br />PERMIT NO.: / M-1991-071 <br />OPERATION NAME: Bohnen Pit <br />ANNNERSARY DATE: September 6, 2006 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUN'T'Y: Kit Carson <br />~~z <br />l1-06-0,6 <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, on the anniversary date of the permit, an <br />_ _operator shall submit the annual fee,_a report and map showing the extent of current_dis_turbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that aze 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 vour revised written annual report and annual report mau to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since 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: <br />Permittee Name: <br />Address: <br />Lyn Brownfield <br />Kit Carson County <br />P.O. Box 160 <br />Burlington, CO 80807 <br />Phone Number: (719) 346-8139 <br />Fax Number: (719) 346-7242 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach jt~toj this form along with your written report and map. Annual Report instructions are <br />enclosed. ~ ~ <br /> <br />Si~rlatiue of or1Sd{a~ Officer, Owner, or IYesigne~ <br />Date <br />M:~PaRMITIMASTERD000MENTSwI-AF-04 <br />