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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUn1, FEE an~ P~ T REQUEST <br />Park County <br />/M-1986-140 <br />Wright Pit <br />April 13, 2007 <br />$281.00 (Due on or before your anniversary date) <br />Pazk <br />RECEIVE <br />FO 97~99~~ippd6 <br />DIV ISIO~~'~",p"~'~~+~~' <br />1Riv~nd6oF`R+~rarr~atr°~~ <br />Mining and Safety <br />RECEIVED <br />~ MAR 2 6 2001 <br />~Divis~;;n of Reclamation, <br />Mining and Safety <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 your revised written annual report 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 <br />report. <br />Division records indicate the following pemuttee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: David Kintz <br />Permittee Name: Park County <br />Address: P.O. Box 147 <br />Fairplay.CO 80440 <br />Phone Number: (719) 836-4280 <br />Fax Number: (719) 836-4275 <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 />Stgnature of Corporate Offi ,Owner, or Designee <br />-/Z -O7 <br />Date <br />~~. ~c^r ~-~ ,.. - <br />