Laserfiche WebLink
.~ _.. ~ ~ IIIIIIIIIIIIIIIIIII <br />. . <br />112 Attachment <br />Permittee Name: rnlnrarin i ;P., rnmi and <br />~ Operation Name: i <br />Permit No: 77_3Dp <br />Anniversary Date: October 27 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />I <br />~ ~ Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />i ~ Annual Report <br />I_~ Map <br />Remarks: <br />,big~i~ture/' <br />(Rev. 5184) <br />Doc. No. 1805 <br />RECElVEO C1 ~ i - 4 1984 <br />