2005-01-18_REPORT - M1983187

• Permit No: M1983187
• IBM Index Class Name: Report
• Doc Date: 1/18/2005
• Doc Name: Annual Fee/Report/Map
• From: Logan County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

ANNi1Ai. FF,F. and RF,P(lRT RF.nTTFST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Logan County
M-1983-187
Knes Gravel Pit
November 8, 2004
$688.00 (Due on or before your anniversary date)
Logan
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urv•
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 shall submit the annual fee, a report and map showing the extent of current disturbances to affected
land; reclamation-accomplished to-date and during-the preceding year; riew distur6anoes 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 your revised written annnal rennrt and annnal re( n~ rt m~ to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Byron D. Hickox
Pennittee Name:
Address:
Logan County
315 Main St., Ste. 2
Sterling, CO 80751
Phone Number: [phone]
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 f Corporate Offic •, Owner, or Designee
Date ~~~
~~
M:~PERMITUrASTERDOCUMENTSNI-AF-04