2006-01-23_REPORT - M1977567

• Permit No: M1977567
• IBM Index Class Name: Report
• Doc Date: 1/23/2006
• Doc Name: Annual Fee/Report/Map
• From: Saguache County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

i
Ito RECEIVE®
~JAN232006
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Airport Pit
November 25, 2005
$281.00 (Due on or before your anniversary date)
Saguache
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-i16, each year, on the anniversary date of the permit, an
opera or s a su mtt t e annua ee, a report an map s owing t"--~ 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 ynnr revised written anmial rennrt and anneal re,Qnrt map to this form. 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: John T. Ungefug
Permittee Name: Saguache County
Address: P.O. Box 655
Saguache, CO 81149
Phone Number: [phone]
Fax Number: [phone]
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 Corporate Officer, Owner, or Designee
Date
Division uf~~r~ and Geology
/ ANNiiAi. FF,F, end REPORT RF.nTTF,ST
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'~ Saguache County ~ V" ~CJt7~
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M:IPERMITNIASTERD000MENTS~M-AF-04