2009-10-20_REPORT - M1991080 - Laserfiche WebLink

Home Browse Search

PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNIVERSARY DATE: ANNUAL FEE DUE: COUNTY: 0 ?, I -r ANNUAL FEE and PORT REQUEST Russ Van Egmond /M-1991-080 Stones Ranch Grav Pt October 25, 2009 ?.? cr $$323.00 (Due on or before your anniversary date) Teller 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 accom lished to date and during the recedin year, new, disturbances that are anticipated to occur during the upcoming year, reclamation that will be performe during-t e coming year, e a es ror e` e inrt n -- - 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. If no new disturbances or reclamation have occurred during the previous year and no new changes to the previous Year's map are necessarv, 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: Russ Van Egmond Permittee Name: Russ Van Egmond Address: 546 Doe Valley Rd. Guffey, CO 80820 Phone Number: (719) 689-0877 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. aWature of Corpor to r-, Owner, or Designee Date