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xpr <br />R <br />ANFEE and REPORT REQUEST - <br />AtEIVED <br />L <br />PERMITTEE NAME: C'Kit Carson County NOV' ©7 2011 <br />PERMIT NO.: v M- 2006 -049 Division of Reclamation, Mining & Safety <br />OPERATION NAME: Smith Pit <br />ANNIVERSARY DATE: November 28, 2011 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Kit Carson <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: Paula Weeks <br />Permittee Name: Kit Carson County <br />Address: P.O. Box 160 <br />Phone Number: <br />Fax Number: <br />Date <br />Burlington, CO 80807 <br />(719) 346 -8139 <br />(719) 346-7242 <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 e along with your written report and map. Annual Report instructions are <br />enclosed. <br />,c-o orpora e Of cer, Owner, or Designee <br />M:IPERMIT\MAS TERDOCUMENTS\M -AF -04 <br />