2006-10-10_REPORT - M2000089 - Laserfiche WebLink

Home Browse Search

~~d12 /d /3 -O~p ~LS PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNNERSARY DATE: ANNUAL FEE DUE: COUNTY; `Ignacio Vasquez Sr t/ M-2000-089 Perdue October 4, 2006 RF~Fi vnr VET ~.. r vision of ? ~~~ Mipin4aRaSaea op $281.00 (Due on or before your anniversary date) Boulder According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, 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, rc~ ,-tam aticn~c~nptished-m-data-arrd-during-ttr~preccding year; isew ui"sturoanc"" es that are aniic'pat'ed o oc-f- cut' 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 your revised written annual report and annual resort mau to this form. The Annual Report & Fee requirement is not met until we have received the following components: fee, report, and associated man. If no new disturbances or reclamation have occurred durinti the previous year and no new chanties to the previous year's map are necessary, then no new map is required, urovided 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 petTrtittee contact information. Please verify and make any necessary changes: Permittee Contact Penttittee Name: Address: Phone Number: Fax Number: Ignacio Vasquez Sr Ignacio Vasquez Sr P.O. Box 938 Lyons, CO 80540 (303) 823-5684 v~ 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.