Laserfiche WebLink
~,~ <br />t/ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Park County <br />M-1980.251 <br />Ansley Flat Pit <br />April 1, 2003 <br />RECEIVED <br />APR 0 9 2003 <br />Division of Minerals and Gealo~~ <br />$281.00 (Due on or before your anniversary date) <br />Park <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,'reclamatiori accomplished"tb-date and during th`e 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 />PI ase e~ aftarh ynnr revised written annual rennrt and anm~al rennrt m,~ to this form_ please note that an <br />adequately labeled map that clearly delineates and includes the above elements may sufftce for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Robert Vance <br />Permittee Name: <br />Address: <br />_ .Phone Number: <br />Fax Number: <br />Park County <br />P.O. Box 147 <br />Fairplay, CO 80440 <br />(719)836-2771 <br />(729} 836-4275 <br />{~ ~ - - - - - <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 />Signature of Co at Officer, caner; or Destgnee <br />~l~l~ <br />Date r ~ <br />M:IPERMITMASTEAD000MENTSUI-AF-04 <br />