2004-07-08_REPORT - M1981085

• Permit No: M1981085
• IBM Index Class Name: Report
• Doc Date: 7/8/2004
• Doc Name: Annual Fee/Report/Map
• From: N Colo Water Conservancy Dist
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

~~
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNP/ERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
N Colo Water Conservancy Dist
M-1981-085
Riprap Quarry Area
July 21, 2004
JUL 08 2004
Division c~ .; ;,,e,.,,.. & GeoloAY
$688.00 (Due on or before your anniversary date)
Grand
___ __ According to C.R.S. 34_32.5.116 or C_R.S. 34-32-11_6, each yeaz, 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 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 your revised written annual report and annual report man 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 permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: r,.._.. n .v,....~._,.,a_
Permittee Name: N Colo Water Conservancy Dist
Address:-.~~.wx-6'r^r

Phone Number:
Fax Number: ~940j-66-3-69~~
Jim Struble
220 Water Avenue
Berthoud CO 80513
{970) 532-7700
[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.
~.
Signa of Corp r cer, Owner, or Designee
~~7~y
Date
M: W ERMI7VMASTERDOCUMENTS~hI-AF-04