Laserfiche WebLink
ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNiJAL FEE DUE: <br />COUNTY: <br />Jackson County Road and Bridge <br />M-2006-060 <br />BLM West Gravel Pit <br />December 19, 2007 <br />~~ <br />DEC 0 6 2007 <br />Division ofa a 6 ¢ ~Y n~ <br />Mining <br />$$791.00 (Due on or before your anniversary date) <br />Jackson <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-o~cur~ent_ distur-bances-to-affec±ed - - - -- <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 your revised written annual report and annual report map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous year's map are necessary, then no new map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />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: <br />Permittee Name: Jackson County Road and Bridge <br />Address: 188 Grant St. <br />P.O. Box 488 <br />Walden, CO 80480 <br />Phone Number: (970) 723-4481 <br />Fax Number: (970) 723-8437 <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 />enclose ~ <br />Signature Corporate Officer, Owner, or Designee <br />!~~-~~ <br />Date <br />M:~PERMITIMASTERDOCLJMENTS~M-AF-04 <br />