2007-08-01_REPORT - M2000084

• Permit No: M2000084
• IBM Index Class Name: Report
• Doc Date: 8/1/2007
• Doc Name: Annual Fee/Report/Map
• From: Washington County
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

~~ %V~I I
ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Washington County
~M-2000-084
Chris Aaegeson Pit #2
August 30, 2007
R~G~~~~®
~-AUG 012007
Vision of Reclamation,
Mining and Safety
$323.00 (Due on or before your anniversary date)
Washington
~c
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
'operatoF shall submit t~ annual fee, a report and map showing the exteni 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 vour revised written annual report and annual report map to this form. The Annual
Report & Fee requirement is not met until we have received the following components: fee, report, and
associated map. If no new disturbances or reclamation have occurred durinc the previous year and no
new chances to the previous year's map are necessary. then no new map is required, provided that the
Operator shall state this in the Anneal Report. Please note that an adequately dabeled map that clearly
delineates and includes the above elements may suffice for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary•..
changes: ®®~ /~
Permittee Contact: Jesse Stackhouse ~it/Z~ ~ P~
v- r
Permittee Name: Washington County ~~~.~~ ~7 ~vt
Address: 150 Ash ~ - ~ " 9. ~ O b - t3' -~` °~ 00
13, 9. ~.~-s
Akron, CO 80720 ^^ f
Phone Number: [phone] - Cc/l 9 ~o - ss Y -/039 ~ O VC 'e ~I 2 r'1 ~1'~~ ~ 2~
Fax Number; [phone] ~ ~, ~ O'+~-~
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. L ~¢- N d t7 t-c1N e-/2 .-G~c-~ /
ature of Co rate O facer, Owner, or Designee ~ ~ IV G~ ~ S L tr+
~'-/ - ~-- 0~0 7
Date
M:~PERMIT~MASTERDOCUMEMS~M-AF-04