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<br />:~ d'a~~d~'~~
<br />PERMITTEE NAME:
<br />PERMIT NO.:
<br />OPERATION NAME:
<br />ANNIVERSARY DATE:
<br />ANNUAL FEE DUE:
<br />COUNTY:
<br />Howard and Barbara Stone
<br />M-1991-080
<br />Stones Ranch Grav Pt
<br />October 25, 2003
<br />$281.00 (Due on or before your anniversary date)
<br />Teller
<br />OCT 2 3 2003
<br />~~~ieien of ^7irsrels.nd Ceoh~~
<br />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
<br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land,
<br />.,..,.»...»,,,,,, ,,,,,,,,,,,Y..,,...,...., ..,..., ........,.....b ...., r..,.,.,.....b ~,.,.., ..,... ....,.,...,.....,.,., ...... ,..., ,......,.r.....,...., .,.,.,,..
<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 attach ynnr revised written annnal rennrt and annnal rennrt m ~n to this form- Please note that an
<br />adequately labeled map that clearry delineates and includes the above elements may suffice for a written report.
<br />Division records indicate the following permittee contact information. Please verify and make any necessary
<br />changes:
<br />Permittee Contact: Howard & Barbara Stone
<br />Permittee Name: Howard and Barbara Stone
<br />Address: 8292 Teller Rd., No. 1
<br />Florissant, CO 80816
<br />Phone Number: (719) 689-227.7
<br />Fax Number: ~'~~°~ '~ 2,7 '7
<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 />~~ N
<br />Signature of Corporate Officer, Owner, or Designee
<br />Dates
<br />M 9PERMITMASTERD000MENTS~M-AF-01
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