2010-08-26_REPORT - M2007012 - Laserfiche WebLink

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ANNUA FEE and REP dRT REQUEST PERMITTEE NAME: G egory Larson PERMIT NO.: 2007-012 OPERATION NAME: Larson Pit ANNIVERSARY DATE: September 21, 2010 ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) COUNTY: Phillips RECEIVED 1AUG 2 ?,$9rJ 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 or 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. 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 brevious vear's map are necessarv, 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: Permittee Name Address: Gregory Larson Gregory Larson 14977 Co. Rd. 97 Haxtun, CO 80731 Phone Number: (970) 580-3119 Fax Number: 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. CZ2:? _1901- Signature of orate Officer, Owner, or Designee /g" . '2?; 6;2-c)/ U Date