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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Bridalveil Construction <br />M-2001-054 <br />Bridalveil <br />October 28, 2004 <br />$281.00 (Due on or before your anniversary date) <br />Ouray <br />.,, :. <br />.. , .. <br />` ~.C p`' ~u~~ <br />-~'c^; <br />= Hccoramg co l:;K.J. J4-3G.J-115-Oi F..K.J ~4=.JL_ i~agn yeas. nn me annrversait+ ua[e_ox_me~er[rur,.an.operaro~- __ -. <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attarh.ynnr revised written anneal rennrt and anneal re~nrt m to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br /> y <br />Permittee Contact: Emery L. Olin <br />Permittee Name: Bridalveil Construction /~ <br />Address: 1796 N. Main St. ~~ <br /> P.O. Box 1412 ~~~ <br /> Ouray, CO 81427 `~ <br />- - - - - - - ~ <br />- <br />Phone Number: (970) 325-4674 ' <br />Fax Number: C@~QQ ,( d ~- -~ r('.(~t/yt i~ <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 enclosed. <br />Signature o Corporate Officer, Owner, or Designee <br />Date <br />~L : -t-c~w~~j A ~e~s~'C~L <br />