Laserfiche WebLink
\ f f <br />J" <br />j <br />ANN eALEE and REPORT REQUEST <br />PERMITTEE NAME: Baca County <br />PERMIT NO.: ?1-1995-019 <br />OPERATION NAME: Mundell Estate No. 32 <br />VWCONW <br />?pR "Z 6 2010 <br />Div+s+ron ct K??on, <br />ANNIVERSARY DATE: May 1, 2010 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Baca <br />-- -- < Accerdir-?g-to-GRS. 34-32.5=1.1-6_or__C.B-S-34-32--LL6,_eac_h.Tear,_Q_n,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: Glen R. Ausmus <br />Permittee Name: Baca County <br />Address: 741 Main St. <br />Springfield, CO 81073 <br />Phone Number: (719) 523-6532 <br />Fax Number: (719) 523-6584 <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. <br />4 <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />M-(PERMIT WIASTERDOCUMENTS WI-AF-04