2006-11-13_REPORT - M1977163SG - Laserfiche WebLink

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bl"zlz~ PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNNERSARY DATE: ANNUAL FEE DUE: COUNTY: ~/ ANNUAL FEE and REPORT REQUEST '~ Lincoln County / M-1977-163-SG Fisher Pit November 21, 2006 ~~~~ it-i~~ ~RECEI!!E!~ lar~V ' ~ 706 Division of Reclamation, Mining and Safety $688.00 (Due on or before your anniversary date) Lincoln operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning of active operations, and the date active operations ceased for the year, if any. Please attach your revised written annual resort and annual report map to this form. The Annual Report & Fee requirement is not met until we have received the followiug components: fee, report, and associated mao. If no new disturbances or reclamation have occurred durinc the previous year and no new chances to the previous year's map are necessarv,then no new map is required, provided that the Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. Division records indicate the following permittee contact information. Please verify and make any necessary changes: Permittee Contact: Don Blake Permittee Name: Lincoln County Address: P.O. Box 39 Phone Number: Fax Number: Hugo, CO 80821 (719)743-2337 (719) 743-2815 If you have additional comments and/or information that should be provided to the Division, please provide it below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. Signature of Corporal fficer, Owner, esignee ~~ov y 2~a ~ Date M:~PERMITMASTERD000MENTSUr-AF-0~i