2009-04-15_REPORT - M1998103

• Permit No: M1998103
• IBM Index Class Name: REPORT
• Doc Date: 4/15/2009
• Doc Name: Annual Fee/Report/Map
• From: Town of Limon
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Email Name: JLE
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE and REPORT REOUEST
Town of Limon
/M-1998-103
Patty's Pit
April 10, 2009
67 K-
? le.
RECEIVED
APR 15 2009
Division of KecLimation,
Ming and Safety
ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date)
COUNTY: Elbert
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 shat-l-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 man 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 year's map are necessary, then no new map 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 suffice for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Dave Stone
Permittee Name: Town of Limon
Address: P.O. Box 9
Limon, CO 80828
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.
?IYGlli?l
Signature of Corporate Officer, Owner, or Designee
Date
M:IPERMITIMAS TERDOCUMENTS W-AF-04