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ANNUAL FEE and REPORT REQUEST /J <br />i'Q'1 ! 7 Z?!i,i <br />Division c' q - -' <br />PERMITTEE NAME: Colorado City Metropolitan District iv;in,,,, ~,~ ?~~~~~'On, <br />Y <br />PERMIT NO.: M-1979-158 <br />OPERATION NAME: Mountain Shadows Pit <br />ANNIVERSARY DATE: December 20, 2006 <br />ANNUAL FEE DUE: $$688.00 (Due on or before your anniversary date) <br />COUNTY: Pueblo <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 sfial~~ubmit~he_annuallee, a repott_and_mapshowing.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 attach your revised written annual reoort and annual report man to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, resort. and <br />associated maa. If no new disturbances or reclamation have occurred durinc the previous year and no <br />new chances to the urevious year's maa are necessary, then no new mao is required, arovided 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: Frank Main <br />Permittee Name: Colorado City Metropolitan District <br />Address: 4497 Bent Brothers Blvd <br />P. O. Box 19390 <br />Colorado City, CO 81019 <br />Phone Number: (719) 676-3396 <br />Fax Number: (719) 676-3172 <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 />.l ~L ~ I , <br />' ature/of Co~orate Officer, Owner, or Designee <br />Date <br />M:~PERMITMASTERDOCUh~NTSVN-AF-04 <br />