Laserfiche WebLink
Gb~ <br />i <br />RECEI~/E® <br />FEB 2 2 2006 <br />Division of Minerals and Geology <br />PERMITTEE NAME: Glenn Southwick <br />PERMIT NO.: M-1986-007 <br />OPERATION NAME: Masonville Stone <br />ANNNERSARY DATE: March 11, 2006 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Larimer <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 operator <br />shall submit the annual fee, a report and map showing the extent of cun•ent disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />doting-the-upcernixg~ar,-->~~'ametierrthat-will-be-pe-formed-during-thz-carrringyear, t1tE-ii ates-for t}ie~innmg <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written anneal refit and anneal re~nrt man to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Glenn Southwick <br />Permittee Name: Glenn Southwick <br />Address: 220 WCR 84 <br />P.O. Box 1103 <br />Wellington, CO 80549 <br />Phone Number: (970) 568-3579 <br />Fax Number: (970) 568-0602 <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 enclosed. <br />>~ ~~ <br />Signature of Corporate Officer, Owner, or Designee <br />a-~o- oc~ <br />Date <br />