2008-08-01_REPORT - M1977184

• Permit No: M1977184
• IBM Index Class Name: REPORT
• Doc Date: 8/1/2008
• Doc Name: Annual Fee/Report/Map
• From: City of Fort Collins
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
AlOiAL FEE and REPORT REQUEST
/?C-- of Fort Collins
t ? -1977-184
Timberline Pit
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4AUG 0 1
2x08
j l9ieision of Reclarpation
ft S)Rd szft?y ,
August 15, 2008
$791.00 (Due on or before your anniversary date)
COUNTY: Larimer
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the
? ary 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 the 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.
i
Please attach your revised written annual report and annual report man to this form The Annual Report &
Fee requirement is not met until we have received the following components: fee. report, and associated map.
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: Mark Sears
Permittee Name: City of Fort Collins
Address: P.O. Box 580
Fort Collins, CO 80522
Phone Number: [phone]
Fax Number:
If you have additional comments and/or information that should be provided to the Division, please provide it below
or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
Signature o Corporate Offic er, or Designee
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Date I I
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