Laserfiche WebLink
A r i K?r-l <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT RE UEST <br />FRock-N-Pine LLC <br />/ M-2003-074 <br />Rock-N-Pine <br />February 5, 2011 <br />??ce`vs <br />L/ MAR 2®11 <br />Dtvion of {K?C?aCn61• <br />t0 and 1"i <br />$$323.00 (Due on or before your anniversary date) <br />Park <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 disturbances that are anticipated 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 may to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />man. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous year's may are necessary, 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 suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Mark Balderson <br />Permittee Name: iP n'-?? C <br />Address: <br />Phone Number: <br />Fax Number: <br />P A- Box 1393- <br />=Breekenr-dg??80424 - - <br /> <br />q - -0 '7 q,6 <br />-{:)'836-986 -71 M9)-836--",O q ((1 <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 Corporae Ofricer, Owner, or Designee l / <br />8 <br />Date