Laserfiche WebLink
cK>t 8D2S1f` ~ L8$ `~' <br />• ~~ ~• <br />ANNUAL FEE and REPORT REQUEST RECEIVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUF.: <br />COUNTY: <br />L.G. Everist Inc. <br />M,1k996-049 <br />Maryland Creek Ranch <br />December 2Q, 2000 <br />$688.00 (Due on or before your anniversary date) <br />Summit <br />DEC t ° X000 <br />Division of Minerals and Gealagy <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 [he extent of current disturbances [o 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 he 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 vour revised written annual reaorl and annual remort mam to this form. Please Wore that an <br />adequately labeled map that c/early delineates and includes [he above elemeu[s may suffice for a m~ritlen <br />report. <br />Division records indicate the following pernrittee contact information. Please yeti nd make any necessary <br />changes: <br />Perminee Contact. Lynn E. Mayer ~N <br />.--~ <br />Perntittee Name: L.G. Everist Inc. <br />Address: 7321 E. 88th Ave., Ste. 200 <br />Henderson, CO 80640 <br />Phone Number. (303) 287-4656 <br />Fax Number: (303) 289-1348 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or atach it to this form along with your vvrinen report and map. Annual Report instnlctions are <br />Sign re f Corp rate Officer or Owner <br />/Zr8®o <br />Date <br />M ~~PER M ITU1P.STE RDOCUMENTSUI-AF-01 <br />