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REP42273
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REP42273
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Entry Properties
Last modified
8/25/2016 12:44:07 AM
Creation date
11/27/2007 9:33:07 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
M1994103
IBM Index Class Name
Report
Doc Date
6/6/2003
Doc Name
Annual Report
Permit Index Doc Type
Annual Fee / Report
Media Type
D
Archive
No
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<br /> ANNiIAi, FF.F, and RF.Pt)RT RF,niJF.ST AFCF <br /> ~V~ <br /> D <br />~ <br />PERMITTEE NAME: Costilla County ~~v/Sl° <br />~6 ~0~3 <br /> ° <br />•`M'n <br />I erdtS <br /> r °°~C°0J <br />OPERA <br />T ON NAME: Sier <br />a Grande Site O9y <br />ANNIVERSARY DATE: June 6, 2003 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Costilla <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 ynnr revised written anneal rennrt and annual rennrt man to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Elizabeth Pacheco <br />Permittee Name: <br />Address: <br />Costilla County <br />P.O. Box 100 <br />I`~AYNEw VA(,.4E'~+ <br />Co~rt]_1_g Cou~Yv <br />1p• O • (ao X 13b <br />San Luis, CO 81152 cS R~ ~~t~5 CO S I IS" ~. <br /> <br />Fax Number: (719) 672-3962 t ~ < < 3003 <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 />~a~ /~ ~- <br />Signature of Corporate Officer, Owner, Designee <br />~j zsl /03 <br />Dale <br />M:~PERMITVNASTE RDOCUMENTSUI-AF-04 <br />
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