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~ ~ ~-~ i <br />ANNUAL FEE and REPORT REQUEST <br /> <br />y. , <br />PERMTITEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~ Grand County <br />~M-1995-004 <br />Inspiration Point <br />May 5, 2007 <br />i ..., O ~, 2Qt~] <br /> <br />$$688.00 (Due on or before your anniversary date) <br />Grand <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 vour revised written annual report and annual report maa to this form. The Annual <br />Report & Fee requirement is not met until we have received the followiug components: fee, report, and <br />associated moo. If no new disturbances or reclamation have occurred during the previous veer and no <br />new chanties to the urevious year's map are necessary, then no new map is reuuired, 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 since jor a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Ken Haynes <br />Permittee Name: Grand County <br />Address: 467 E. Topaz Ave. <br />P.O. Box 9 <br />Phone Number: <br />Fax Number: <br />Granby, CO 80446 <br />(970)887-2123 <br />(970) 887-3168 <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 />~~~~ ~~ ~ <br />Signature of Corporate O facer, Owner, or Designee <br />~1.3/O~ <br />Dale <br />M:IPERMITMASTERDOCUMENTS~f-AF-0+1 <br />