2010-04-12_REPORT - M1999003 - Laserfiche WebLink

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PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNIVERSARY DATE: ANNUAL FEE DUE: COUNTY: .1 //41 r A rALElfand ORT REQUEST A fert Construction Z-1999-003 Tallahassee Pit April 8, 2010 $$323.00 (Due on or before your anniversary date) Fremont P?(? ee of D > A e) 10\% 'ygAN. 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 man 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 necessary, 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: d i€ert? i r? ?? Permittee Name: Seifert Construction Address: P.O. Box 305 Westcliffe, CO 81252 Phone Number: (719) 783-2757 U0•0 /30? 021v Jr C- Fax Number: -1/9 -78 3 - 99 0 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. Signatur f Corp ate er, Owner, or Designee 01 C) Date