2010-09-07_REPORT - M1977479 - Laserfiche WebLink

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r / `7 r r A AL FEE and REPORT REQUEST RIVED PERMITTEE NAME: ? ca County ?--p - 7 2010 PERMIT NO.: M-1977-479 OPERATION NAME: Walsh Pit No. 2 ? qt RedaM OM, ANNIVERSARY DATE: September 11, 2010 ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) COUNTY: Baca 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 vour 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 chanLyes to the previous vear's man 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: Glen R. Ausmus Permittee Name: Baca County Address: 741 Main St. Springfield, CO 81073 Phone Number: (719) 523-6532 Fax Number: (719) 523-6584 If you have additional comments and/or information that should be provided to the Division, please provide it beVw or attach it to this form along with your written report and map. Annual Report instructions are 3i?nature of CNT;orate Officer, Owner, or Designee x-,46 Date M: \PERMrI1MAS TERDOCUMENTSIA4-AF-04