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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Kit Carson County <br />M-1989-004 <br />Raymond Duell Pit <br />Apri126, 2003 <br />DECEIVED <br />APR 141003 <br />Oielsion of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Kit Carson <br /> <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 the extent of current disturbances to affected <br />~la*+~*PclamationaccomplishecLto.date_and:during=the_preceding_year,_new_disturbances_that:are-anticipated_to _ _ _ __ <br />occur during the upcoming year, reclamation that will be 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 your revised written anneal rennrt and anneal report maw to this form. please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: 1 r ,,() <br />Permittee Contact: Walt Isenbart 1 1~~-r ~ l ~ 1/I ~i ~ l UY <br />Permittee Name: Kit Carson County I , <br />Address: 251 15th St. <br />P.O. Box 160 <br />Burlington, CO 80807 ~ v~ <br />Phone Number: (7-19) 346-8133 ~~ ~-~-) -~ ll, - - ~ c~~ - - <br />Fax Number: (719) 346-7242 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />Dale <br />M:~PERM ITUTASTERDOCl1MENTS~M-AF-00 <br />