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ANN AL FEE andr PORT REQUEST <br />PERMITTEE NAME: Lincoln County <br />PERMIT NO.: L'MLi-1978-079 AMA'Y <br />0 4 3009 <br />OPERATION NAME: Daugherty Pit <br />V Vi ii:!;- or" y u.b"A? <br />ANNIVERSARY DATE: May 24, 2009 C//(/?/? <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Lincoln <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 may. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous vear's map are necessarv, 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 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: Kenneth Morrison <br />Permittee Name: <br />Address <br />Phone Number: <br />Fax Number: <br />Lincoln County <br />P.O. Box 39 <br />Hugo, CO 80821 <br />(719) 743-2337 <br />(719) 743-2815 <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 />Sign ture of Corporate Officer, Owner, or Designee <br />Date <br />M:IPERMIT\MASTERDOCUMENTSM-AF-04