Laserfiche WebLink
PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />fA ?7 k- RP7- <br />ANrNNUAL FEE and REPORT REOUEST <br />Vcostilla County <br />, <br />M-1999-024 ' <br />San Acacio Gravel Pit <br />October 4, 2010 <br />$791.00 (Due on or before your anniversary date) <br />COUNTY: Costilla <br /> <br /> <br />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 <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 vour 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 chances 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 since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Mathew L. Valdez <br />Permittee Name <br />Address: <br />Phone Number: <br />Fax Number: <br />Costilla County <br />352 Main St. <br />San Luis, CO 81152 <br />(719) 672-9109 <br />(719) 672-3003 <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 />-M(6? V" X-- <br />Signature of Corporate Officer, O r, or Designee <br />to l? 1 t6 <br />Date <br /> <br /> <br /> <br /> <br />ar,?ry` <br />is <br />M:\PERMIT\MASTERDOCUMENTS\M-AF-04