2007-03-16_REPORT - M1995009 - Laserfiche WebLink

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ANNUAL FE)~ and 1~ PORT REQUEST PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNIVERSARY DATE: ANNUAL FEE DUE: COUNTY: - Dorman Brothers LLC - M-1995-009 Fasse Pit April 5, 2007 Y ~ . Divisro~,c~~c:~ ,.~""on, Mining and Safety $$688.00 (Due on or before your anniversary date) Kit Carson According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversazy date of the permit, an operator _shall_submit the annual fee, a report and map showing the extent of current disturbances to affected land, reclamation accomplished to date and during the preceding year, new distLrh~n~PC that aze~anticinated to occur during the upcoming yeaz, reclamation that will be performed during the coming year, the dates for the beginning `- ofactive operations, and the date active operations ceased for the year, if any. Please attach vour revised written annual reuort and annual report map to this form. The Annual Report & Fee requirement is not met until we have received the following components: fee, resort, and associated map. If no new disturbances or reclamation have occurred durinc the previous vear and no new chances to the previous year's map are necessary, then no new map is required, provided that the Operator shall state this in the Annual Report. Please note that an adequately labeled map that c/early delineates and includes the above elements may suffice for a written report. Division records indicate the following permittee contact information. Please verify and make any necessary changes: Permittee Contact: Michael B. Dorman Permittee Name: Dorman Brothers LLC Address: 19230 County Rd. 55 Phone Number: Fax mb you h v below igna r of Cc Date Burlington, CO 80807 (719)346-7970 X46-7971 Tonal co t nd/or information that should be provided to the Division, please provide it to this fo 1 with our written report alnd map. Annual Report instructions are enclosed. 7rr~~/el orate Officer, Owner, or esignee