2012-02-01_REPORT - M1981043 - Laserfiche WebLink

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PERMITTEE NAME: Colorado Division of Highways PERMIT NO.: 11981 -043 OPERATION NAME: ANNIVERSARY DATE: ANNUAL FEE DUE: COUNTY: 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 cha11 submit the annual fee, a report and map showing the extent of current disturbances to affected land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning of active operations, and the date active operations ceased for the year, if any. Please attach your revised written annual report and annual report map to this form. The Annual Report & Fee requirement is not met until we have received the following components: fee, report, and associated map. If no new disturbances or reclamation have occurred during the previous year and no new changes to the previous year's map are necessary. then no new map is reuuired, provided that the Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. Division records indicate the following pennittee contact information. Please verify and make any necessary changes: Permittee Contact: Jeremy Lucero Pernlittee Name: Colorado Division of Highways Address: 222 S 6th St Rm 317 Phone Number: (970) 683 -6223 Fax Number: (970) 683 -6227 Si _ -`#' gate Officer, Owner, or Designee Date M:\PERMrrMAS -AF -44 ANNI FEE and REPOR &4 ST Grand Junction, CO 81501 N Of Douglas Pass February 1, 2012 $323.00 (Due on or before your anniversary date) Rio Blanco Rmsc or information that should be provided to the Division, please provide it with your written report and map. Annual Report instructions are .5� tt S Y ak i\-A 1 -2 Pk ,4 uc` .- -cocf