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~~.~ j~° <br />ANNUAL FEE and PORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />l <br />Rio Grande County <br />`/M-1987-020 <br />374 Pit <br />Apri123, 2008 <br />l~ <br /> <br />'APR 2 ~. 2008 <br />Divos~ar: a. txeciu~vlatiu7t, <br />t/ Mining and Sagety <br />$$791.00 (Due on or before your anniversary date) <br />COUNTY: !Rio Grande <br />According to C.R.S. 34-32.5-116 or'~,i;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, date_ s_for t_h_e_ <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 />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: Patrick Sullivan <br />Permittee Name: Rio Grande County <br />Address: <br />168 N. Washington <br />Monte Vista, CO 81144 <br />Phone Number: (719) 852-4781 <br />Fax Number: (719) 852-0305 <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 />enc <br />c3~%'~/ <br />Signature of Corporate Officer, Owner', or Designee <br />Date <br />M:~PERMIT~IvIASTERDOCLTMENTS~M-AF-04 <br />it <br />