2009-06-25_REPORT - M1978143

• Permit No: M1978143
• IBM Index Class Name: REPORT
• Doc Date: 6/25/2009
• Doc Name: Annual Fee/Report/Map
• From: Grand County
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REOUEST
Grand County
M-1978-143
Kremmling Airport
July 27, 2009

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$791.00 (Due on or before your anniversary date)
Grand
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. Ifno_new disturbances or reclamation have occurred during the previous year and no
new changes to the previous year's may 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:
Permittee Contact:
Permittee Name:
Address
Phone Number:
Fax Number
Ken Haynes
Grand County
467 E. Topaz Ave.
P.O. Box 9
Granby, CO 80446
[phone]
[phone]
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.
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Signature of Corporate Officer, Owner, or Designee
D
Date
M: PERMIT1MASTERDOCUMENTS\N4-AF-04