2005-11-21_REPORT - M1985129

• Permit No: M1985129
• IBM Index Class Name: Report
• Doc Date: 11/21/2005
• Doc Name: Annual Fee/Report/Map
• From: Elbert County
• To: DMG
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
~~utiu ~ ~~~~~ ~~~
ANNiIAi. FF.F. and REPORT RF.~iiF.ST
~,,, RECEIVED
Ell~rt County
l,~I/1985-129 ~~V 1
Elbert County Pit ~DiVision of Minerals and Geology
November 25, 2005
$688.00 (Due on or before your anniversary date)
Elbert
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
_ _ oQerator shall submit the annual fee, a report and map showing the extent of current distur_ba_nces_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 ynnr revised written annnal rennrt and annual rennrt mx~ to Chic 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: ~
Permittee Name: Elbert County
Address: CF.PR.address 1 ~1
P. O. Box 116
Kiowa, CO 80117
Phone Number: [phone]
Fax Number: [phone]
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Fif3FJZ7' ~ounh-~l
P.O go x 1110
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303-14,21-3 r ~7
303 -dal -31x9
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.
Si""g~~nature of Corpor e Office Owner, or Designee
Zuo,lEm6EQ a aoaS'
Date
M:~PERMITNIASTERDOCUMENTSN-I-AF-04