Laserfiche WebLink
~ ~, I,zi <br /> c/ANNUAL FEE and REPORT REQUEST <br /> RECEI\/~~ <br />PERMITTEENAME: i/ <br />David Goss ~ <br /> / EC <br />~ ~ ~~~~ <br />PERMIT NO.: I/ M-1985-140 ~vfsi®n ®t~gj~, <br />OPERATION NAME: Goss Sand & Gravel Minlt~g@ylQ§ <br />ANNIVERSARY DATE: January 24, 2007 <br />ANNUAL FEE DUE: $$281.00 (Due on or before your anniversary date) <br />COUNTY: EI Paso <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />re~amahon accomplishe~lc to date~an Ong etapreceding year, new isYurb~ances that aze anticipated to occur <br />during the upcoming yeaz, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />I~~ <br />Please attach your revised written annual report and annual report map to this form. The Annual Report <br />8: 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 durinc the previous vear and no new chances 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 since for a written report. ~ ^ ,~1 ~~ ~',y~ L ~ <br />v/ / <br />Division records indicate the following permittee contact information. Please verify and make a y necessary <br />changes: <br />Permittee Contact: David Goss <br />Permittee Name: David Goss <br />Address: Rt. 2, 6759 Ellicott Hwy. <br />Calhan, CO 80808 <br />Phone Number: (719) 683-2415 <br />Fax Number: (719)- 83=3250 ~,,,~~ ~ z v <br />~~,_,~~. <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 aze enclosed. <br />Signature of Corporate Officer, caner, or esi ee <br />Date <br />