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41 .,. r ~ . + gMw <br />rifi~~rw.ii <br />112 Enclosure <br />,;' I ~ 2 - nor <br />Permittee Name: Corn Construction Co <br />Permit No: M-79-089- ~ "~~~EDIAND~F('l.A~~AT;6''3 <br />Operation Name: 23 ROAD PIT I, ~. „ , <br />Anniversary Date: 07 / 25 / 85 -' '- <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />_~ Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />Annual Report <br />Map <br />Remarks: <br /> <br /> MINED LAND RECLAMATION DIVIS~- N~ 3 9 5 2 <br /> 1313- Sherman Street Room 423 ~/` <br />Denver, CO 8003 DATE ~ '19 il]L <br />(30 <br />3) 866-356 <br />7 <br /> / <br />/ <br />~r~ l L71~.S7rl~~_tI UY~ _ <br />I ( <br />' <br />RECEIVED FriON <br /> ~{ <br />~/ <br />] <br />THE SUM DF~. /1Cb717 ~/!-5AI1d ~ ~ llb-IC~l10f~DOLLAFIS $ ~t ' d~. <br />^ ca9+ <br />`~$[CFECK <br /> <br /> AMOUNT OF ACCOUNT...... $ ~'tiank ~ou! <br /> AMOUNT PAID ................ $ <br /> <br /> BALANCE DLIE ............... $ BY <br /> <br />Signature <br />