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~~~~~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />'Joseph L. and Arlene Cogan <br />/M-1998-091 <br />Arnold Gulch <br />February 19,2007 <br /> <br />rdAN 2 21001 <br />p'ry/~sion ofa d Safety n <br />/ Mlining <br />$$281.00 (Due on or before your anniversary date) <br />Chaffee <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 operator <br />shall submit the annual fee, a report and map showing the extent of cun•ent disturbances to affected land, <br />reclamation_ accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates foi the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred durine the previous Year and no new changes to <br />the previous Year's map are necessary. then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Joseph L. Cogan <br />Permittee Name: Joseph L. and Arlene Cogan <br />Address: P.O. Box 113 <br />Nathrop-CO 81236' "- -- ~- - <br />Phone Number: (719) 395-2339 <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 enclosed. <br />S~ lure o Corporate Off er, Owner, or Designee <br />/707 <br />Date <br />