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rCo <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />V ANNiiAi. FF.F, and REPORT RF.OTTF.ST <br />Saguache County <br />/M-1995-075 <br />Coleman Pit <br />Apri125, 2006 <br />R~C~I U~© <br />`MAR 2 7 p006 <br />`"fin o! Minerals antl <br />c3o°yrgf. <br />$688.00 (Due on or before your anniversary date) <br />Saguache <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 showing the extent 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 year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach yQnr revised written ann gal re~orf and annnal resort main to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since 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: John T. Ungefug <br />Permittee Name: Saguache County <br />Address: P.O. Box 655 <br />Saguache, CO 81149 <br />Phone Number: (719) 655-2554 <br />Fax Number: (719) 655-2534 <br />2.3n,.la~ /~t i-i rrr_ don~r> v <br />Po>3 ~~~ <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />Si lure of o rate Officer, Owner, or Designee ~i~)1 ~F ~ <br />APP~iOVAL <br />Date <br />M:~PERMITNrASTE2DOCUMENTNN-AF-04 <br />