Laserfiche WebLink
ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: /John R. Kurtzer <br />PERMIT NO.: ./~YI-2002-053 <br />OPERATION NAME: Kurtzer Pit <br />ANNNERSARY DATE; November 27, 2006 <br />ANNUAL FEE DUE: $$281.00 (Due on or before your anniversary date) <br />COUNTY: Phillips <br />~~~ <br />t~~ <br />v ~° I~ <br />o,~;s FF9 ps ~~ <br />/n'n92 asaf~~~oq <br />_Ac_co~ding 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 d~shubances 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 [he <br />beginning of active operations, and the date acfive 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 durinc the previous veer and no <br />new chances to the previous year's map are necessary. then no new man 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 since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Pennittee Contact: John R. Kurtzer <br />Permittee Name: John R. Kurtzer <br />Address: 24463 CR 11 <br />Haxtun, CO 80731 <br />Phone Number: (970) 774-7122 <br />Fax Number: (970) 774-3265 <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 enclosed. <br />~f-s ~`~ Ct~Q;~,~~,, ~ I ,fin , _ ~2~~- ~ a~o~ <br />Sign-~CorporateOfficer or Owner VI~~~ "^'""' ~~ C~ C~~~/~.~ 2~ 15 I ~~ <br />Date <br /> <br />