Laserfiche WebLink
PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <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 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 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: <br />Permittee Name: <br />Address: <br />Phone Number: (719) 275 -2047 <br />Fax Number: <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 />Signat <br />Date <br />'747/ <br />M:IPERMITIMAS TERDOCUMENTS\M -AF -04 <br />Curtis Stone <br />Fremont County <br />1170 Red Canyon Rd. <br />Canon City, CO 81212 <br />iG <br />e of Corporate Officer, Owner, or Designee <br />ANN AL FEE and REPORT REQUEST <br />% /Tremont County <br />X -1994-118 <br />Phantom Canyon Pit <br />August 8, 2011 <br />$$323.00 (Due on or before your anniversary date) <br />Teller <br />rli c 75— 1,00 <br />FGS <br />ECEIVSO <br />I/JUL 2 8 2011 <br />4 ivision of Reclamation, <br />Paining and Safety <br />