Laserfiche WebLink
~' III IIIIIIIIIIIIIIII <br />1) <br />Permittee Name: <br />Permit No: Jim Helmericks <br />Operation Name: M-85-001- <br />Anniversary Date: J 6 J PIT <br />06 / 27 / 86 <br />~~~~~ ~E~1~Gre <br />JUN 8 )gg) <br />Min d Land <br />RPClama 'on Division <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />Annual Report <br />Remarks: Iti{~ ~~v J~ - t~~ ( ~ ~~~ <br />\ ILO i J2~ S D~-~C~,!`, <br />' ~ .2c ~ <br /> <br />i <br />~~~~~~ <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />--~ ~ r~~ <br />Signature <br />C~~ <br /> <br />'C~~~ <br /> <br />