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44 <br />fw L <br />ANN AL FEE"and PORT REQUEST <br />RECEIVED <br />PERMITTEE NAME: PL,.ncoln County I/MAY /?0 3 ? . , <br />PERMIT NO.: -1978-078 Division of Reclamation <br />OPERATION NAME: Pickenpaugh Gravel Pit Mining & Safety <br />ANNIVERSARY DATE: May 24, 2011 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Lincoln <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 vear'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 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: Kenneth Morrison <br />Permittee Name: <br />Lincoln County <br />Address: <br />P.O. Box 39 <br />Hugo, CO 80821 <br />Phone Number: (719) 743-2337 <br />Fax Number: (719) 743-2815 <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 />Sig ature of Corporate Officer, Owner, or Designee <br />X12,17 ,z0 / I. <br />Date <br />M: PERMIT WA S TERDOC UMENTS\M-AF-04 <br />