Laserfiche WebLink
ma w ov-- <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />kWashington County <br />"M-1998-065 <br />Hayes Pit <br />September 18, 2009 <br />?ECEWED <br />SEP 0 2009 <br />Division CT-; .;IG??ru4i?n, <br />$$323.00 (Due on or before your anniversary date) <br />Washington <br />_-_-A?r-cording_to CR.S_3_4_32.5-U6 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 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: Jesse J. Stackhouse 7 Y4 C Lt. ?/ SS <br />Permittee Name: Washington County / 0 <br />Address: 150 Ash Avenue `-cam ?-? s??Jo ?` <br /> <br /> Akron, CO 80720 <br />Phone Number: (970) 345-2701 ?j ) T r? / Iq ? /"t'1 I` N ?( <br />Fax Number: (970) 345-2702 <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 />enclose . <br />nature of rporate Officer, Owner, or Designee <br />Date <br />M:IPERMITIMASTERDOCUMENTS\N4-AF-04