2005-09-19_REPORT - M1987072

• Permit No: M1987072
• IBM Index Class Name: Report
• Doc Date: 9/19/2005
• Doc Name: Annual Fee/Report/Map
• From: Stanley J Conner
• To: DMG
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Stanley J Conner
//IGI-1987-072
Lee No 2 Placer
September 26, 2005

~EP 19 2005
~Divisian srf Minerals and Geology
$225.00 (Due on or before your anniversary date)
Gilpin

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
oyerator shall submit the annual fee,_a_rePort_and~rtap_shoyving_the_extent_of_current_disturbances_to_affected--- .- -
land, 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 your revised written annnal report and annnal report ma, to 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:
Permittee Contact: Stanley J. Conner
Permittee Name: Stanley J Conner
Address: P.O. Box 102073
Denver, CO 80250-2073
Phone-Number:'- [phone] " ' - ' - -- -- -- --~ - ---- - - ` -"
Fax Number:
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. Annual Report instructions are
enclosed.
Signature of C rte Of rcer, Owner, or Designee
9 ~-1 ~ --- 0 5~
Date
M:~PERM17Vv1ASTERDOCUMENTS/M-AF-02.DOC