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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />iii iiiiiiiiiiiiiiii <br />999 <br />~~ <br />ANNUAL FEE and REPORT REQUEST <br />Fremont County <br />M-1490-138 <br />Stirrup Pit <br />January 20, 2002 <br />RECEOV ED <br />JAN 1 4 2002 <br />Gy~ision of Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Fremont <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised written annual report and annual resort map to this form. Please note that an <br />adequately labeled map that clearly delineates artd includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: -Kerl£~ea <br />Permittee Name: Fremont County <br />Address: ~P-t3:-l3tnr39'S <br />Phone Number: (=i-}9~9#2-4'IT$ <br />Fax Number. t,'to;o^' "t~°- <br />C~~TSS'~toNGa~~ST~7 Su.Q~, <br />bts ~lrkCOra FlV~ <br />~t°l-Z~b- ~3~ <br />~l°1 `~b•~32o <br />~r ~ •~S• ~6ua <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 or Owner <br />\~ 1'10 l <br />Date <br />M:~PER M R V.7 A ST E R DOC U M EKr5N7 ~ AF-OJ <br />