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^/ <br />[~~ <br />. /~~ ; ~~i <br />ANNIiAT. FRF, and REPORT RFOiiFST <br />G <br />R~G~I~! z® ~ <br />PERMITTEE NAME: Lake County ,/ ~ ,~ <br />PERMIT NO.: _ I-1977-459 QQT,,~' ZQQS <br />OPERATION Nt1wIE: Lake County Grav Pit '~ <br />Division of PAiavrois U Geology <br />ANNIVERSARY DATE: JUIy 8, 2005 <br />ANNUAi, PEE DUE: $688.00 (Due on or before your anniversary date) <br />COUi I'I'Y: Lake <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 vnnr revised written anm~al report and annnal report man to this form. Please note that an <br />adequately laheled 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 />Permittee Contact: Jer <br />Permittee Name: Lake County <br />~RD QAi_rti1~~2 <br />Address: Road and Bridge <br />P.O. Box 964 <br />Leadville, CO 80461 <br />Phone Number: (719) 486-0259 <br />Fax Number: (71 '7! ~ - 4 Flo - 8 X79 <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 />Signa a of orporate Officer, Owner, or Designee <br />~o~i~~~s <br />Da[c <br />MdPER,bllTM AS' PERPOCUM E,V 1'SM-AF-0S <br />