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~~ ~ ~ s ~~~i ~i ~.~-- ~5 <br />/~ t ~~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNITAi. FF.F. and RF.PnRT RF.niJF.ST <br />~an County ~ ' ~ M <br />~'IVI-1993-069 <br />Lindstrom Gravel Pit <br />November 26, 2005 <br />$688.00 (Due on or before your anniversary date) <br />Logan <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 />=~--iarid; re~laination at<complishzd'to~dafe'and'during-the peecedingyzar; nzw-disturbancesthat arc~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 ~qur revised written annual report and annual re~.rnrt main to this form- Please note that an <br />adequately labeled map that clearly delineates and 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: Byron D. Hickox <br />Permittee Name: Logan County <br />Address: 315 Main St., Ste. 2 <br />Sterling, CO 80751 <br />Phone Number: (970) 522-7879 <br />Fax Number: (970) 522-4018 <br />kluS~,Jr1 ~, r/' ~Lp~h-ii~ <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 />t <br />Signatu orate Officer, Owner, or Designee <br />`tS -~ <br />Date <br />M:~PEAMITMASTERDOCUMENTSiM-AE-o4 <br />