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~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME.: <br />ANNIVERSARY DATE: <br />ANNiJAL FEE DUE: <br />COUNTY: <br />n <br />, <br />EE an P RT REQUEST <br />/ La Plata County <br />~M-1977-575 <br />Marvel Pit <br />Apri122, 2008 <br /> <br />~`~~' <br />i~AR 3 ~ 2008 <br />®imtson o, <br />! A~9an'n9 and Safi ion, <br />tY <br />$$323.00 (Due on or before your anniversary date) <br />La Plata <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 of current disturbances to affected <br />- - - --land, reela:nation-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 iio 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: `Halter A. Serfoss <br />Permittee Name: l:a Plata County <br />Address: 1.365 S. Camino Del Rio <br />Durango, CO 81303 <br />Phone Number: (970) 382-6417 <br />Fax Number: (970) 247-8279 <br />If you have additional <br />below or attach it to <br />Officer <br />Date <br />information that should be provided to the Division, please provide it <br />with your written report and map. Annual Report instructions are <br />or <br />M: ~PERMITVVIASTERDOCUMEPTCS~Ivi-AF-04 <br />