Laserfiche WebLink
<br /> <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />r <br />ANNUA FEE and REPORT REQUEST <br />Acme Brick Company <br />?M-1989-052 <br />Dakota Clay Pit <br />October 25, 2009 <br />C" <br />$$323.00 (Due on or before your anniversary date) <br />Jefferson <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 operator <br />shall submit the _annual_ fee,__ a report -and _map= showing the -extent-of -current= disturbances--to--a€fected-land, <br />__reclamation-accomplished-to_date.and-during-the-preceding year, new disturbances-that are--anticipated to occur- <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised written annual report and annual report may to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the Drevious vear's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: Robert Tibbetts <br />Permittee Name: Acme Brick Company <br />Address: 401 Prairie Hawk Dr. <br />Castle Rock, CO 80109 <br />Phone Number: (303) 688-6951 <br />Fax Number: (303) 688-5270 <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 enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />.??e?' •, p' .zov <br />Date