2005-10-13_REPORT - M1978066

• Permit No: M1978066
• IBM Index Class Name: Report
• Doc Date: 10/13/2005
• Doc Name: Annual Fee/Report/Map
• From: Rio Grande County
• To: DMG
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
l~io Grande County
-1978-066
10 Miles South Pit
October 22, 2005
$688.00 (Due on or before your anniversary date)
Rio Grande
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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 shall submit the annual fee, a report and map showing the extent of cun•ent 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 ynnr revised written annnal report end annual report men to this form- Please note that an
adequately labeled map that clearly delineates and tncludes the above elements may since for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Lawrence "Buddy" Shaver
Petmittee Name: Rio Grande County
Address: 168 N. Washington
Monte Vista, CO 81144
Phone Number: [phone]
Fax Number: [phone]
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If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
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Signature of tporate Officer, Owner, or Designee
Date
M:~PERMITMASTERD000MENTSNr-AF-04