2008-03-11_REPORT - M1995009 - Laserfiche WebLink

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~~'; ~~~ ANNUAL FEE and REPORT REQUEST PERMITTEE NAME: ~ Orman Brothers LLC ~~~® PERMIT NO.: M-1995-009 ~AR 1 120$ OPERATION NAME: Fasse Pit vision o9 Reaa ANNIVE mation, Mining and Safet RSARY DATE: April 5, 2008 y ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) COUNTY: Kit Carson 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 shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, _ . _ ___ .reclamation accomplished to date and during th_e 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 vour revised written annual report and annual reuort map to this form The Annual Report & Fee requirement is not met until we have received the following components: fee, report, and associated man. If no new disturbances or reclamation have occurred durin the previous year and no new changes to the previous year's map are necessary, then no new map is required, provided that the Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. Division records indicate the following permittee contact information. Please verify and make any necessary changes: Permittee Contact: Michael B. Dorman Permittee Name: Dorman Brothers LLC Address: 19230 County Rd. 55 Phone Nu Fa umber: If you below Burlington, CO 80807 (719) 346-7970 19) 3 6-7971 Tonal co s and/or information that should be provided to the Division, please provide it to this Ong with your written report and map. Annual Report instructions are enclosed. ~~ Officer, Owner Desi 7x ~~ Date /