2005-12-02_REPORT - M1997015

• Permit No: M1997015
• IBM Index Class Name: Report
• Doc Date: 12/2/2005
• Doc Name: Annual Fee/Report/Map
• From: Washington County
• To: DMG
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Washington County
!~ M-1997-015
Elrick Pit
December 19, 2005
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$688.00 (Due on or before your anniversary date)
Washington
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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 current disturbances to affected land,
- - -reclamation accornpiish~d°tsdate anttZiurirrg the p c c i ~ ear,-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.
P1eace attach~mn• revised written annnal re~prt and annnal rr~prt martn this form- Please note that as
adequately labeled map that clearly delineates and includes the above elements may since for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
Permittee Contact: C-~r}ie-3:-If~te
Permittee Name: Washington County
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Address:
Otis, CO 80743
Phone Number:
Fax Number:
5014th Ave
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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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ature of C orate Officer, Owner, or Designee
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Date