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~~ .~ ~ <br />ANNUAL FEE and REPORT REQUEST <br />av~~~ <br />PERMITTEE NAME: Charles W Houchin ~(~~~~~~® <br />PERMIT NO.: M-1980-249 <br />OPERATION NAME: Houchin Gravel Pit .IAN ~ 2 Z~~S , i ^ a d la ~ n, <br />Division of Reclamation, fe <br />ANNIVERSARY DATE: February 4, 2008 Mining and Safety <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: El Paso <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 current disturbances- to affected land, <br />-- - - <br />--re-c~la~ - i~ a ~ ,,~,~i hc~-~ozlai~ a~~d uarrirrg-tl~e ~~c~iirg jTear; r~ew=disturoances rya are anticipacec~t`o occur <br />during the upcoming year, reclamation that will be performed during-the coming year, the dates for the beginning <br />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 Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous year's map are necessary, then no new map is reauired, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may sufftce for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Charles Houchin <br />Permittee Name: Charles W Houchin <br />Address: P.O. Box 162 <br />Green Mountain Falls, CO 80819 <br />Phone Number: (719) 684-9285 <br />Fax Number: (715) 684-2695 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or~.txa~l~iLtq this form alon~w}~h your written report and map. Annual Report instructions are enclosed. <br />Signat/u/rJe of C~/7o7rpo/r/ate O icer, Owner, or Designee <br />Date <br />