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 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 hat'wi11 tie performed during the coming year`the3ates forte egmnmg <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 year's map 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: Emery L. Olin <br />Permittee Name: Bridalveil Construction <br />Address: 1796 N. Main St. <br />P.O. Box 1412 <br />Ouray, CO 81427 <br />Phone Number: <br />Fax Number: <br />970) 325 -4674 <br />ANNUAL FEE and REPORT REQUEST <br />Bridalveil Construction <br />M- 2001 -054 <br />7 Division of Reclamation, <br />Mining & Safety <br />9 <br />October 28, 2011 <br />$323.00 (Due on or before your anniversary date) <br />Ouray <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 />7 — a // <br />Date <br />!RECEIVE', <br />7 0CT 272011 <br />