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ANNUAL FEE and REPORT REQUEST <br /> <br />PERMITTEE NAME: Homer Monks Construction, Inc. RECE! VED <br />PERMIT NO.: M-1998-103 APR p ~ 10p2 <br />OPERATION NAME: <br />ANNIVERSARY DATE: Patty's Pit <br />April 10, 2002 Division of Minerals and Geology <br />ANNUAL FEE DUE: $281.00 (Due on or before your annive rsary date) <br />COUNTY: Elbert <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 [o affected land, <br />- reclamation accomplisfied to date and-during-tlre-prez2dirrg°year; ttew-disturbatces-that-ate-articipated'to-occur- - <br />during the upcoming year, reclamation that will be performed during the coming year, the dates far the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual resort and annual report map to this form. Please note that an <br />adequately labeled map that clearly 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: Patty L. Monks <br />Permittee Name: Homer Monks Construction, Inc. <br />Address: P.O. Box 1207 <br />Phone Number: <br />Fax Number: <br />Limon, CO 80828 <br />(719) 775-2328 <br />(719) 775-8707 <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 [his form along with your written report and map. Annual Report instructions are enclosed. <br />~j~~~ <br />?--.- <br />Signature rporate Officer or Owner <br />a`-9- ~ ~- <br />Date <br />M:~PERMrtVNASTERDOCUMENTSU~I-AF-01 <br />