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T <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />I <br />� <br />r i <br />ANN ffLFEE and RE OR REQUEST <br />k it Carson County <br />/M- 2006 -049 <br />Smith Pit <br />November 28, 2009 <br />W aft" <br />fC 2 4 2009 <br />Division of Reclamation, <br />.t Mining and Safety <br />$$323.00 (Due on or before your anniversary date) <br />Kit Carson <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 <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: Carol Fritz <br />Permittee Name: Kit Carson County <br />Address: Chairman <br />P.O. Box 160 <br />Burlington, CO 80807 <br />Phone Number: (719) 346 -8139 <br />Fax Number: (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 this form along with your written report and map. Annual Report instructions are <br />enclosed. r <br />ure of Corporate fficer, Owner, or Designee <br />I; log <br />Date <br />M: \PERMITIMASTERDOCUMENTS\M -AF -04 <br />