Laserfiche WebLink
d~ <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: ~ Ricky W. Mitchell <br /> <br />PERMIT NO.: /M-1990-131 <br />OPERATION NAME: Mitchell Pit #2 <br />ANNIVERSARY DATE: February 14, 2007 <br />ANNUAL FEE DUE: $$281.00 (Due on or before your anniversary date) <br />COUNTY: Adams <br />07<<5~orl <br />ReceivEe <br />/`~FEB 1 3 2007 <br />+' Division of Reclamation, <br />Mining and Safety <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished- to dale-and~during~the-preceding year, new disturbances that are_anticipated to_occur __ _ _ <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised written annual report and annual report map to this farm. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />ma . If no new disturbances or reclamation have occurred durinc the previous vest and no new chances to <br />the previous vest's map are necessarv, then no new map is required. provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes; <br />Permittee Contact: Ricky W. Mitchell <br />Permittee Name: <br />Address: <br />Ricky W. Mitchell <br />P.O. Box 10 <br />Bennett, CO 80102 <br />Phone Number: (303) 644-4102 <br />Fax Number: <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 enclosed. <br />Signature of Ce rate Officer, Owner, or Designee <br />;~/i~/®~ <br />Date <br />