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~~f~~ <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />N Colo Water Conservancy Dist <br />/M-1981-086 <br />Borrow Area C <br />July 21, 2007 <br /> <br />RECE~VE~ <br />~~~N 287007 <br />ii:Sivision of ReGamation, <br />1vLning and Safety <br />$$688.00 (Due on or before your anniversary date) <br />Grand <br />_ ~___ According_to C.R.S._3.4,32.5=116_or_C.R.S._34-32-Llb,.each..year,_on-theanniversar3~-date-o~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 your revised written annual report and annual report map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred durinc the previous vear and no <br />new chances to the previous year's map are necessary, then no new map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Jim Struble <br />Permittee Name: N Colo Water Conservancy Dist <br />Address: 220 Water Avenue <br />Berthoud, CO 80513 <br />Phone Number: (970) 532-7700 <br />Fax Number: (970) 532-0942 <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 />L.+i ~ ,...~~ <br />tgn~ o Cor ra cer, Owner, or Designee <br />lolr~ ~2oa 7 <br />Date <br />M:IPERM171MASTERDOCUMENTSNI-AF-04 <br />