2007-05-08_REPORT - M1995023

• Permit No: M1995023
• IBM Index Class Name: Report
• Doc Date: 5/8/2007
• Doc Name: Annual Fee/Report/Map
• From: Corkle Construction
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.: '
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
AF ~~nT
ANNUAL FEE and REPORT REQUEST
,/Corkle Construction
t/I1I-1995-023
Corkle Pit
June 8, 2007
$$281.00 (Due on or before your anniversary date)
Jackson
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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
____ __shalLsubmiLthe_annuaL.fee._a renort and man showing the extent of current disturbances to affected land,
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur----
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach vour revised written annual renort and annual renort man to this form. The Annual Report
& Fee requirement is not met until we have received the following components: fee, report, and associated
map. If no new disturbances or reclamation have occurred during the arevious vear and no new chanties to
the previous year's moo are necessary, then no new moo is required, provided that the Operator shall state
this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the
above elements may since for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Harry E. Corkle
Permittee Name: Corkle Construction
Address: Box 306
..t ., ~ _ 7

Walden, CO 80480 _
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
Signature Corporate Officer, Owner, or Designee
s s ~a~
Date