Laserfiche WebLink
~~~~~~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Sedgwick County <br />M-1996-073 <br />Dolezal Gravel Pit <br />November 8, 2003 <br />$281.00 (Due on or before your anniversary date) <br />Sedgwick <br />OCT 2 2 2003 <br />[livision of Minerals and Geolam~ <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 />- --eperate~shall submit-the_annual_fee,_a_report_and~nap_slwwing_tlte_extent_of_current_disturbances.to_affec[ed <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 ynnr revised written anneal rennrt and anneal report man 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: <br />Permittee Contact: Randy Renquist <br />Permittee Name: Sedgwick County <br />Address: 223 S. Cedar <br /> Julesburg, CO 80737 <br />P-hone-Number:- (9~0}4.74-3576 _ _ - _ _.___ __ _ ___ <br />Fax Number: (970) 474-3558 <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 />St natur-~ ` e of Cb orate Of tcer, Owner, or Desi ee <br />g rP ~ <br />Dale <br />ACCOUNT NO~~ // fj- <br />AMOUNT $ a S~t P 0 <br />MiPEAM ITMASTERDOCUM ENTSVN-AF-04 <br />