2005-08-11_REPORT - M2000084

• Permit No: M2000084
• IBM Index Class Name: Report
• Doc Date: 8/11/2005
• Doc Name: Annual Fee/Report/Map
• From: Washington County
• To: DMG
• Media Type: D
• Archive: No

A n i
PERMTTTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
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Washington County 'f"I' v '"1
.iM-2000-084
Chris Aaegeson Pit #2
August 30, 2005
$281.00 (Due on or before your anniversary date)
Washington
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_ According-to_C.R.S. 34-32.5-116-or_C.R.S._34-32-116; each-year,-on the-anniversary date-of 4he permit; an
---operator-shall-submit-the-annusl-fee,-a-report-and-map-showing-the_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 anneal rgpnrt and anneal re~nrt to this form. please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
R 2T /1c l NP ~-*~
Permittee Contact: r'b ' ~ r ~' /~ dt4 ~ ~S G SS ~ ~~ SS ~ S~ C-~~ C,f $ e-
Permittee Name: Washington County
Address: I50 Ash
Akron, CO 80720
Phone Number: [phone]
Fax Number: [phone]
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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.
' ature of Cora e Officer, Owner, or Designee
~ / ~ oos
Date
M:~PERMITNrASTERDOCUMEM5Vv1-AF-04