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~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />r/ ANNUAL FEE and REPORT REQUEST <br />'~ Elbert County <br />/ M-2001-056 <br />Belveal Gravel Plt <br />November 9, 2006 <br />RECEI~/ED <br />~~t/p~ 2 4 2006 <br />" _rvMnin9a dS faey n, <br />$281.00 (Due on or before your anniversary date) <br />Elbert <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 yeaz, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised written annual resort and annual report man to this form. The Annual <br />Report & Fee requirement is not met until we have received the Following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the arevious year and no <br />new changes to the urevious year's mao are necessary, then no new map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Tim Sheridan <br />Permittee Name: Elbert County <br />Address: 809 Ute Ave <br /> l <br />Simla, CO 80835 <br />Phone Number: (719) 541-2268 <br />Fax Number: (719) 541-2826 <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 Co orate Offi, er, er, oror D ~ <br />~ // cr ~ <br />Date <br />M:WERMITMASTERDOCUMEN'rSVN-AF-04 <br />