2008-12-01_REPORT - M2006060

• Permit No: M2006060
• IBM Index Class Name: REPORT
• Doc Date: 12/1/2008
• Doc Name: Annual Fee/Report/Map
• From: Jackson County Road & Bridge
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

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ANNUAL FEE and REPORT REOUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Jackson County Road and Bridge V
oa
M-2006-060 ?
BLM West Gravel Pit
December 19, 2008
$791.00 (Due on or before your anniversary date)
Jackson
200Y
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
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.
Please attach your revised written annual report and annual report map to this form. The Annual Report
& Fee requirement is not met until we have received the following components: fee, report, and associated
map. If no new disturbances or reclamation have occurred during the previous year and no new changes
to the previous vear's map are necessary, then no new may is required, provided that the Operator shall
state this in the Annual Report. Please note that an adequately labeled map that clearly delineates and
includes the above elements may since for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes: /
US 1. ?i
Permittee Contact: ?J? y ?t/oPI I S. e Q j ?O?n rGr CV
Permittee Name: Jackson County Road and Bridge QC6 ek b lj n 100;
Address: 188 Grant St.
P.O. Box 488
Walden, CO 80480
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attgch it to this form along with your written report and map. Annual Report instructions are enclosed.
Signature of i5orporate Officer, Owner, or Designee
Date
M: PERMITIMASTERDOCUMENTS\M-AF-04