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~'`~-- <br />~~ °Ir ~~T <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />,~ <br />City of Golden <br />M-1977-534 <br />Empire Pit <br />January 30, 2008 <br />Divicivr+ ~'i :~acla~~4ioo, ~/ <br />~ioir~g ~nt~ Zafe4y V <br />$$791.00 (Due on or before your anniversary date) <br />Clear Creek <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-repor-t 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-lie 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: Dan Hartman <br />Permittee Name: City of Golden <br />Address: Director of Public Works <br /> 911 Tenth St. <br /> Golden, CO 80401 - - " -- - " <br />Phone Number: (303) 384-8000 <br />Fax Number: (303) 384-8161 <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 />en osed. <br />Signature of Corporate Officer, Owner, or Designee <br />l g ~8 <br />Date <br />M:~PERMIIIMASTERDOCUMENTSV~f-AF-04 <br />