REP44981

• Permit No: M1982186
• IBM Index Class Name: Report
• Doc Date: 9/28/2005
• Doc Name: Annual Rpt
• From: Kit Carson County
• To: DMG
• Media Type: D
• Archive: No

.~iU~l,~~ L ~~
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNiiAi. FF.F, and REPORT RF. i~ iF.CT
Kit Carson County ~(`
~YGI-1982-186
Beeson Pit
October 28, 2005
hrn ~<
RECEIVEC
~EP 2 82005
)., Division of Minerals and Geology
$281.00 (Due on or before your anniversary date)
Kit Carson
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, 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 ym~r revised written annnal ~nrt and annnal report m,~ 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 fallowing permittee contact information. Please verify and make any necessary
changes:
Ly
Permittee Contact: Lynda Brownfield
I y
Permittee Name: Kit Carson County
Address: P.O. Box 160
Burlington, CO 80807

Ph
N
b J 2 ~i/
719
346 33 ~i
one
um
er: (
)
J /
/
Fax Number: [phone] ~
...
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach i~~fo'~his form along with your written report and map. Annual Report instructions are
enclosed. ~ ~
Signature of Corpor e O/ffic ,Owner, or Designee
~~ W ~~S
Date
M:IPERMITVv1ASTERD000MENTSNf-AF-04