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<br />~~~ <br />RECEIVE® <br />PERMTi'TEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />George E. Oten <br />M-1984-013 <br />Mackey Mine <br />May 14, 2005 <br />$225.00 (Due on or before your anniversary date) <br />Gilpin <br />MAY 2 0 2005 <br />Givision of Minerals and Geology <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 sttnch yn rr r .via d written ann ral rennrt and anmral red nrt mgp to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since 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: George E. Often <br />Permittee Name: George E. Often <br />Address: 11438 CR 19 <br />Fort Lupton, CO 80621 <br />Phone Number: (970) 785-2538 <br />Fax Number: <br />~Q~~cJ ~` ~:,C 7" c~ <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 />Officer, Owner, or Designee <br />-~l J <br />Date <br />M:~PERM 1'MIASTERDOCNNENT57M-AF-o2.DOC <br />