Laserfiche WebLink
<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Costilla County <br />M-1980-233 <br />Costilla <br />~~~~~~~® <br />DEC 0 5 2003 <br />December 11, 2003 Division of Minerals and Geola?~' <br />$281.00 (Due on or before your anniversary date) <br />Costilla <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 />* ~ ~~ °^~^~~' '''° °° ual-fee,-a report-and map'showing the extenfof current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated [o <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 yQnr revised written anm~al rennrt and anneal rennrt 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 petmittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Mathew Valdez <br />Permittee Name: Costilla County <br />Address: P. O. Box 130 <br />San Luis, CO 81152 <br />.Phone Number: (719) 672-9109 <br />Fax Number: <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, Own , or Designee <br />6z~3~o3 <br />Date <br />M:\PERMfI~MASiERDOCUMENTSVvf-AE-04 <br />