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J <br />AX811Z FEE an 'PORT REOUEST <br />(fc.5 °x=_ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />?ZtCarson County <br />1991-071 <br />Bohnen Pit <br />September 6, 2009 <br />RECEIVE <br />AAUG 2 2009 <br />Division of Reclamation, <br />U? Mining and -Sana'i,, <br />$$323.00 (Due on or before your anniversary date) <br />Kit Carson <br />-According _to C.R.S_3.4_32.5.__1-1.6.-or: C.R.S-3.432-116,_each year, on the anniversary date _of the _permitr.an_ _ <br />operator shall submit the annual fee, a report and map showing the extent of currei?disturb-ances 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 man 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 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: Carol Fritz <br />Permittee Name: Kit Carson County <br />Address: P.O. Box 160 <br />Burlington, CO 80807 <br />Phone Number: <br />Fax Number: <br />(719) 346-8139 <br />(719) 346-7242 <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 's for along with your written report and map. Annual Report instructions are <br />closed. <br />igna re of Corpor Officer, Owner, o Designee <br />Date <br />M: \PERMITIMAS TERDOCUMENTSIM-AF-04