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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANN& L FEE Zf]R ORT REQUEST <br />7 'Gunnison County <br />W-1991-104 <br />Nicolas Pit <br />September 17, 2008 <br />$323.00 (Due on or before your anniversary date) <br />Gunnison <br />/g G 2 2008 <br />-According tom.R_S 34--32.5- ll_6_or_C.R.S_34-32-1.1.6,-each-year,,-on_the_anniversary date_ofAhe_permit,-an-operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, reclamation <br />accomplished to date and during the preceding year, new disturbances that are anticipated to occur during the <br />upcoming year, reclamation that will be performed during the coming year, the dates for the beginning of active <br />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 Report & <br />Fee requirement is not met until we have received the following components: fee, report, and associated may. <br />If no new disturbances or reclamation have occurred durine the previous year and no new chances to the <br />previous year's may are necessary, then no new may is required, provided that the Operator shall state this in <br />the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the above <br />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: Marlene Crosby <br />Permittee Name: Gunnison County <br />Address: 811 Rio Grande <br />Gunnison, CO 81230 <br />Phone Number: (970) 641-0044 <br />Fax Number: (970) 641-8120 <br />If you have additional comments and/or information that should be provided to the Division, please provide it below <br />or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />S' ture of Corporate Officer, Owner, Designee <br />E3113 toe <br />Date <br />M:\PERMIT\MASTERDOCUMENTS\M-AF-04