Laserfiche WebLink
w <br /> <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE, DUE: <br />COUNTY: <br />Lullett Excavating, LLC <br />6-1(1-2007-007 <br />Mooney Hills Permit <br />June 7, 2011 <br />$$323.00 (Due on or before your anniversary (late) <br />Las Animas <br />© /< <br />ile <br />RECEIVED <br />ddUN u U Zol,l <br />Division of Reclamation, <br />Mining & Safety <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 perfornedduring; the coming year, thc. 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 during the previous year and no new changes to <br />the Previous vear's man 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 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: Myron Mullett <br />Permittee Name: Mullett Excavating, LLC <br />Address: 320 CR 241 <br />P.O. Box 322 <br />Westcliffe, CO 81252 <br />Phone Number: (719) 783-2056 <br />Fax Number: (719) 783-0156 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attacl it to this form along with your written report and map. Annual Report instructions are enclosed. <br />1. ' <br />Si iature of Co rate Officer, Owner, o Designee <br />Ju.? ? ? ?-o>r l <br />Date . <br />