2001-11-11_REPORT - M1996073

• Permit No: M1996073
• IBM Index Class Name: Report
• Doc Date: 11/11/2001
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: ANNUAL FEE/REPORT
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
~II III~IIII~~~~~ ~II
ANNUAL FEE and REPORT REQUEST
Sedgwick County
M-1996-073
Dolezal Gravel Pit
November 8, 2001
RECe!°t~°~
pivision of Mi;,:•- =
$281.00 (Due on or before your anniversary date)
Sedgwick
According [o C.R.S. 34-32.5-I 16 or C.R.S. 34-32-I 16, each year, on the anniversary 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 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 [he year, if any.
Please attach your revised written annual report and annual report map to this form. Please note rhnt nn
udequutely labeled map that clearly delineates mld inchtdes the above elements may suffice fora written
report.
Division records indicate the following permi[tee contact information. Please verify and make any necessary
changes:
Permittee Contact: Randy Renquist
Permittee Name: Sedgwick County
Address: 223 S. Cedar
Julesburg, CO 80737
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 of Corporal fficer or Owner
I ~ ~ ~ /- 0
Dale
AI IPERMITUTASTERDOCUMEMSNI~AF 61