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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Larimer County <br />M-1985-135 <br />Horton Gravel Pit <br />January 31, 2005 <br />$688.00 (Due on or before your anniversary date) <br />Larimer <br />uy <br />`~~'~~ 2C ~r~5 <br />X.17-- <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 />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 yonr revised written anneal red ort and anneal re,Pnrt m to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may sufJlce 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: Dennis C. Momson <br />Permittee Name: <br />Address: <br />Larimer County <br />P.O. Box 1190 <br />Fort Collins, CO 80522 <br />Phone Number: (970) 498-5652 _ <br />Fax Number: (970) 498-5678 <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 />Signature of Corporate`Officer, Owner, or Designee <br />Date <br />M:\PERMI7 VNASTERDOCUMENT54M-AF-04 <br />