REP11503

• Permit No: M1980249
• IBM Index Class Name: Report
• Doc Date: 1/20/2004
• Doc Name: 2004 Annual Report
• From: Charles W Houchin
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE;
ANNUAL FEE DUE:
COUNTY:
Charles W Houchin
M-1980-249
Houchin Gravel Pit
February 4, 2004
$281.00 (Due on or before your anniversary date)
El Paso 'S
JAN 2 i? 2004
Division of Minerals and Geology
According to C.R.S. 34-32.5-I 16 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator
slia~tt submii-fYCe aflt~ua3-fee; a'repart-and map-showing-the-extent of-eureent disturbances to affected-lard,- ---
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 ,~nnr reviced written annual rem and annual refit main to this form- Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written report.
Division records indicate the following pennittee contact information, Please verify and make any necessary
changes:
Permittee Contact: Charles Houchin
Permittee Name: Charles W Houchin
Address: P. O. Box 162
Green Mountain Falls, CO 80819
Phone Number: [phone]
Fax Number: [phone]
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.
Signature of Corporate Officer, Owner, or Designee
Hate T
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