2006-05-01_REPORT - M1989030

• Permit No: M1989030
• IBM Index Class Name: Report
• Doc Date: 5/1/2006
• Doc Name: Annual Fee/Report/Map
• From: San Miguel County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANIVI7A1. FF.F, and REPORT RF.nf TEST
/ San Miguel County
i% M-1989-030
Zadra Pit
May 15, 2006
$688.00 (Due on or before your anniversary date)
San Miguel
RECEIVED
MAY .d 1 ~
Division of
Miners;,. .
_:~a ~.~~,...
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-shalLsubmit.the, annual fee; a-report and_map-showing the extent of:current-disturbances toaffected_--
- -land; reclaliiation accanipti'shed`to~a[e-and'diYring the preceding year, new disturbances tha are anh`cipated~o '
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 your revised written anneal rennrt and anmral regprt m ~n to this 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: Mike Horner
Permittee Name: San Miguel County
Address: P.O. Box 426
Norwood, CO 81423
Phone Number: (970)-327-4835
Fax Number: [phone]
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.
Signature/~ or~ ffi~ cer O er, or Designee
Y//z/o~
Date
M:~PERMI7wfASTERD000MENTSNI-AF-04