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<br />'~ RECEIVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Kit Carson County <br />M-1989-003 <br />Raymond Schulte Pit <br />April 5, 2003 <br />Division of Minerals and Gealody <br />$688.00 (Due on or before your anniversary date) <br />Kit Carson <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_showitlg_the exte_nt,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 yeai,-the dates for the- - <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Ptea_s agtta~h yonr revised written anm~al report and anneal reRQrt m ~n to thic fnrm_ 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: Walt Isenbart <br />Permittee Name: Kit Carson County <br />Address: 251 15th St. <br />P.O. Box 160 <br />Burlington, CO 80807 <br />t--= --Phone Number: ~ - (719) 346-8133 <br />Fax Number: (719) 346-7242 <br />t~~n7 . ~v~-~i-P ~ Cc~ <br /> <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attac~j to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />of <br />7 <br />Dale <br />ANNiiAi. FF.F. and RF.PnRT RF.t1iiFST AP'~ 14 2p03 <br />Owner, or Designee <br />M:IPERMITU7ASTERDOCUM ENTSV.7-AF-04 <br />