Laserfiche WebLink
f <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />-- ?D <br />ANNUAT. FEE and REPORT REQUEST <br />rowers County <br />?M-1984-134 <br />Randy Shaw Pit <br />August 31, 2008 <br /> <br /> <br />'-AIUG 1 2 2000 <br />Division or P,eclamation, <br />H°ning and Wotj <br />$$791.00 (Due on or before your anniversary date) <br />Prowers <br />According to_ C.R.S._ 34-32_5-116 or C.R.S._3.4-32-116, each year, on the anniversary date ofthe _permi.t,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 man 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 />new chances to the previous vear's map are necessarv. then no new map is reauired. 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: Mark Dorenkamp <br />Permittee Name: <br />Address <br />Prowers County <br />109 E. Sherman St. <br />Lamar, CO 81052 <br />Phone Number: (719) 336-5536 <br />Fax Number: (719) 336-5536 <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 />??' z 'K?? <br />Signature of Corporate Officer, O er, or esignee <br />t- / 2 --ES <br />Date <br />M: PERMIT\MASTERDOCUMENTS\M-AF-04