Laserfiche WebLink
<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANN?J`A'L FEE and REPORT REQUEST <br />Tenn Southwick <br />I-1986-007 <br />Masonville Stone <br />March 11, 2011 <br /> <br /> <br />I/ <br /> <br />$$323.00 (Due on or before your anniversary date) <br />Larimer <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, _ <br />-reclamation-.-accomplished -to -date- and-during the-preceding-year, -new-disturGarices tffdtare anfi-6pated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />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 Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred duriniz the previous year and no new changes to <br />the previous Year's map are necessarv, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may suff ce for a written report. <br />Division records indicate the following permittee contact information <br />changes: <br />Permittee Contact: Glenn Southwick <br />Permittee Name: Glenn Southwick <br />Address: 13800 Silver Springs Rd <br />Jay Em, WY 82219 <br />Phone Number: (307) 334-2880 <br />Fax Number: (970) 568-0602 <br />Please verify and make any necessary <br />36-1 - 3 3u - Z?Ba <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 enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />Date