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<br />r 11 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />?'v -§, ?TT <br />ANNUAL FEE and REPORT REOUEST <br />Routt County <br />J M-1979-058 <br />Funk & Hooker Pit <br />April 26, 2010 <br />$791.00 (Due on or before your anniversary date) <br />Routt <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 may 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 chances to the previous year's may 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: Heather R. McLaughlin <br />Permittee Name: Routt County <br />Address: P.O. Box 773598 <br />Steamboat Springs, CO 80477 <br />Phone Number: (970) 870-5337 <br />Fax Number: (970) 879-3992 <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 />Signature <br /> <br />Date <br />; or Designee <br />0010 <br />41'WOR of R?oclamagon, <br />6?GtVnP C?1 Oafety <br />M:\PERM T\IvMSTERDOCUMENTS\M-AF-04