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~~~~~T <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />La Plata County/ <br />M-1977-575 / <br />Marvel Pit <br />Apri122, 2009 <br />L V ~ ~ ,.. % <br />,~ APR ~ ~ 2~0~ <br /> <br />$323.00 (Due on or before your anniversary date) <br />La Plata <br />____ _ 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 _ _ __ <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 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 />new changes to the previous year's map are necessary, then no new map is required, 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 Buff ce for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact:.,~.a~ter e oss ,~ _ ~S <br />Permittee Name: La Plata County <br />Address: 13 <br />Durango, CO <br />~' ~ 3Q ~. <br />Phone Number: ._(970 17 - <br />Fax Number: (970) 247-8279 <br />If you~have additional <br />.below or attach it to <br />enclosed. <br />Signature of Corporate <br />~ C ~c <br />Date / <br />form <br />1- a U = SUr <br />~~7d~ 3b ~. - ~ 3 ~ 3 <br />~~7~~ 3'75_ 798 ~ <br />information that should be provided to the Division, please provide it <br />with your written report and map. Annual Report instructions are <br />Officer, Owner, or Designee <br />M: ~PERMITIMASTERDOCUMENTS~Iv1-AF-04 <br />