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'~ ~ • III IIIIIIIIIIIIIIII ~ <br />999 <br />ANNUAL FEE and REPORT REQUEST <br />PERM[TTEE NAME: Archuleta County <br />PERMIT NO.: M-1994-043 RECEIV E® <br />OPERATION NAME: Klett Gravel Site MAY 2 1 2~_1 <br />ANNIVERSARY DATE: May 25, 2001 <br />ANNUAL FEE DUE: $225.00 (Due on or before your anoiversar{~id~°} Minerals eni ;e°logY <br />COUNTY: Archuleta <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 <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual resort and annual resort maa to this form. Please note that arr <br />adequately labeled map that clearly delinentes and includes the above elemems pray suffice ja• a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Kevin Walters <br />Permittee Name: Archuleta County <br />Address: P.O. Box 1507 <br />Pagosa Springs, CO 81 147 <br />Phone Number: (970) 264-5660 <br />Fax Number: (970) 264-6815 <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 <br />enclosed. <br />Signature of Corporate Officer or Owner <br />5~ I~ ~~ I <br />Da e <br />M'1PERM INAA STERDOCU A1Et~rIS~M-AF-04 <br />