2010-10-01_REPORT - M1982186

• Permit No: M1982186
• IBM Index Class Name: REPORT
• Doc Date: 10/1/2010
• Doc Name: Annual Fee/Report/Map
• From: Kit Carson County
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

A
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AL FEE and REPORT REOUEST
PE:RMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
Kit Carson County
VIM-1982-186
Beeson Pit
October 28, 2010
MCEIVE®
12010
Divimn of r.:;:.,Li;o:atkjn,
jv Wn0 and : ertty
$$323.00 (Due on or before your anniversary date)
Kit Carson
-- -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 may 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 channes to the previous vear'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 fora written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes: ` C-4
.
Permittee Contact: C-arel-Fritz5
Permittee Name:
Address
Kit Carson County
P.O. Box 160
Burlington, CO 80807
Phone Number: [phone]
Fax Number: [phone]
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.
Q6e of Corporate ficer, Owner, or Designee
Date 1
M: \PERMITIMASTERDOCUMENTS\M-AF-04