2010-03-19_REPORT - M1977365

• Permit No: M1977365
• IBM Index Class Name: REPORT
• Doc Date: 3/19/2010
• Doc Name: Annual Fee/Report/Map
• From: Park County
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

APL
F
ANNUAL FEErand4EPOR REQUEST
PERMITTEE NAME: Park County
PERMIT NO.: ?I-1977-365 AR 19 2.010
Sulphur Mtn Gravel Pit Dfi?p of R?lanation,
OPERATION NAME: . V g and Safety
ANNIVERSARY DATE: April 1, 2010 l/
ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date)
COUNTY: Park
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 accomplished to date and during the preceding year, new disturbances that are anticipated to
occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the
beginning 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. 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: David Kintz
Permittee Name: Park County
Address: P.O. Box 147
Phone Number:
Fax Number:
Fairplay.CO 80440
[phone]
[phone]
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.
ignature of Corporate Office , weer, or Designee
-/erZO6 P
Date
M :\PERMTT\MASTERDOCUMENTS\M-AF-04