Laserfiche WebLink
s83W <br />L r <br />A AL FEE panfIREPORT REQUEST <br /> <br />PERMITTEE NAME: 6 ity of Lamar <br />PERMIT NO.: " M-1984-154 <br />OPERATION NAME: Well Field Pit <br />ANNIVERSARY DATE: December 10, 2010 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Prowers <br /> <br />? 0 l 6 2010 <br />plan et'Ksc *ten' <br />to jAKjp9 d <br />According-to- C.R,$- 4:32.5-116 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 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 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: Patrick Mason <br />Permittee Name: City of Lamar <br />Address: 102 E Parmenter St <br />-- -- - - - - - Lamar, C-0-8-1-05-2-3-2-39 <br />Phone Number: (719) 336-4495 <br />Fax Number: (719) 336-4404 <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 />nclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />I S7- 10 <br />Date <br />M: \PERMITIMAS TERDOCUMENTSW-AF-04