Laserfiche WebLink
J <br />s4. -~v <br />RECEIVED <br />PERMITTEE NAME; <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />John O Buckner <br />M-1993-030 <br />Crystaljack Mine <br />Apri126, 2003 <br />$75.00 (Due on or before your anniversary date) <br />Teller <br />APR Z 22003 <br />Division ~f Minerals and Geolosy <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 shalLsubmit_the_annual fee,.a report_and-map showing-the extenEof-current-disnrrbances-to affcctcd - -- <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 ymrr revised written anneal reRnrt and anmral rennrt m~ to this form- Please note shat 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: John O. Buckner <br />Permittee Name: John O Buckner <br />Address: 2516 Waldean St. <br />Colorado Springs, CO 80909-4015 <br />Phone Number: (719) 634-4042 <br />Fax Number: (719) 634-5431 <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 OfScer, wee or Designee <br />4 ~/S~ZOD3 <br />Date <br />M9PERMITUTASTERD000M ENTS/M-AF-02.DOC <br />