Laserfiche WebLink
APtlYUAL FEE a' nd REPORT REQUEST <br />PERMTITEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~ John R. Kurtzer <br />~M-2002-053 <br />Kurtzer Pit <br />November 27, 2007 <br />RE~~~V D <br />~~ 181001 <br />piyisiAn of Rgoiatnratlon, <br />~ Mining end Safety <br />$$323.00 (Due on or before your anniversary date) <br />Phillips <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 />_ _,---she}1=submii°`the =annual .fee, -a-report-and -map-showier-the-ext~..t-nf -cuncrtt-disturbances-tff affected -land,--- - - <br />reclamation accomplished to date 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 resort and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred durinc the previous veer and no new chances to <br />the previous year's map are necessary, then no new map is required, urovided that the Operator shall state <br />this in the Annual Resort. Please note that an adequately labeled map that clearly delineates and includes the <br />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: John R. Kurtzer <br />Permittee Name: John R. Kurtzer _ <br />Address: 24463 CR 11 <br />Haxtun, CO 80731 _ <br />Phone Number: (970) 774-7122 _ <br />Fax Number: (970) 774-3265 _ <br />~lpr. <br />ss ~s C <br />Were Remo~c! <br />?OOG.~o~Do7 <br />If you have additional comments and/or information that should <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />~,~ ~~~ <br />Signature of Corporate Officer, Owner, or Designee <br />~D~/ k~ ~ <br />Date <br />