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��l< °`� Ill �llll�llhr��kll <br /> sss <br /> ANNUAL FEE and REPORT REQUEST <br /> RECEIVED <br /> PERMITTEE NAME: Delta County JAN 2 9 2001 <br /> PERMIT NO.: �14U <br /> OPERATION NAME: Lemoine Gravel Pit Division of Minerals and Geology <br /> ANNIVERSARY DATE: February 16, 2001 <br /> ANNUAL FEE DUE: $688.00(Due on or before your anniversary date) <br /> COUNTY: Delta <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 /> land, reclamation accomplished to 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 annual report and annual report map to this form. Please Wore that an <br /> adequately labeled map that clearly delineates and includes the above elements tnav suffice for it written <br /> report. <br /> Division records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: Q j <br /> Permittee Contact: '- �O/ /"U i ecor <br /> V <br /> Permittee Name: Delta County <br /> Address: 501 Palmer St., Ste. 227 <br /> Delta. CO 81416 <br /> Phone Number: (970) 874-2100 <br /> Fax Number: (970) 874-21 14 <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 /> AignatUref Corporate Officer or Owner <br /> / - '2-�'-- a / <br /> Date <br /> M.IPERM I TMA STERDOCUMENTSMN-A F-04 <br />