2005-08-22_REPORT - M1983130

• Permit No: M1983130
• IBM Index Class Name: Report
• Doc Date: 8/22/2005
• Doc Name: Annual Fee/Report/Map
• From: Elbert County
• To: DMG
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
NNilAi. FF.F and RFP(1RT RF.i1iTF.ST
Ibert County .
~M-1983-130
West Pit
September 22, 2005
$281.00 (Due on or before your anniversary date)
Elbert
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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
operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected
]and, 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 ynnr revised written anneal repnrf and anneal re; nn rt maTtn 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:
Pemrittee Contact:
Permittee Name:
Address:
Phone Number:
Fax Number:
Marilyn Sproch
Elbert County
809 Ute Ave.
Simla, CO 80835
[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. Ammual Report instructions are
enclosed.
Signature of Corpora Officer, O~ r, e~Dg~ignee
/~ ~ i~ d~
Date
M:~PERMITYvfASTERDOCUMENT$4~]-AF-04