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.: <br />~ ~ ~ RPM <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY D~-TE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Town of Limon ~% <br />M-1998-103 <br />Patty's Pit <br />Apri110, 2008 <br />~~~~~- / <br />APR 0 ~ 2000 V <br />Division of tZeciamation, `~ <br />Mining and Safety <br />$$323.00 (Due on or before your anniversary date) <br />Elbert <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,-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 durinE 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 statf~ 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: ]Dave Stone <br />Permittee Name: 'T'own of Limon <br />Address: 1P.0. Box 9 <br />Phone Number: <br />Fax Number: <br />7i 9- 775- 90 ~,3 <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 />enclosed. <br />~2~ <br />Signature of Corporate Officer, Owner, or Designee <br />3/~8,/a8 <br />Date <br />]Limon, CO 80828 <br />1;719) 755-2346 <br />M:~PERMIIIMASTERDOCUME]VTSU~I-AF-04 <br />