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<br />• iii iiiiiiiiiiiuiii ~ <br />~.- ~~ ~1~~1nclosure <br />r -ts G. <br />~ ., r+' . <br />Permittee Name: Corn Construction Company ~ i~o8 <br />Permit No: M-83-013 (;r P, i8 <br />Operation Name: Lathem -Burkett Pit , <br />Anniversary Date: 04l28J88 ~~ ~,_;,~ ~~;,, ;Ire;., <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check spaces? belowl <br />~~ <br />Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />n~ <br />Sic 8%~w+ Annual Report <br />Map <br />Remarks: N~ ~.,;~;,,5 0. ~c~ ~,.,r/,", h ~S ~~~.. P/,.~. „~ td,s p. ! ~/.,~:., <br /> <br /> <br />,~ ~! - t~ - E'£s <br />Si gnat e <br />7350G <br />0054f <br />