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/~~~~PP~ ~~ ~w <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />I{iowa County ~j/'d"Py <br />1991-075 <br />Barnes Pit <br />November 12, 2005 <br />$688.00 (Due on or before your anniversary date) <br />Kiowa <br /> <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 attach ynnr revised written annnal report and annnat re_pnrt m ~n M Chic form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Pennittee Contact: l3ielF1vlc33attiel~ A I len U7. wa, {~ ~'g Allen ~. Ito ~ lS <br />Permi[tee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Kiowa County <br />P.O. Box 100 <br />Eads, CO 81036 <br />(719)438-5810 <br />(719)438-5327 <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 />Si a re of Corporate Officer, Owner, or Designee <br />Date <br />M:~PERMITNIASTERDOCUMENTSVN-AF-04 <br />