2006-09-25_REPORT - M1992060

• Permit No: M1992060
• IBM Index Class Name: Report
• Doc Date: 9/25/2006
• Doc Name: Annual Fee/Report/Map
• From: City of Monte Vista
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

i 4

AERMITTEE NAME:
PERMIT NO..
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
,/ ANNUAL FEE and ~PQRT REtZUF~fiT
'r City of Monte Vista
t~ M-1992-060
Lagoon P[t
October 20, 2006
Cv

sEp 2 s zoos
IVision bf RBGamatinn,
Mining and Safety
$281.00 (Due on or before your anniversary date}
Rio Grande
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 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 yeaz, 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.
Ptease attach vour revised written annual report and annual report man to this form, The Annual
Report & Fee requirement is not met until we have received the fallowing components: fee, resort, and
associated mau. if no new disturbances or reclam tt},~ion have occurred during th~revious year and no
new Chan es to the revious ear's ma arc netessa than na new ma is re uired rovided that the
Ouerator shalt state this in the Anneal 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: Don Van Wormer
Permittee Name: City of Monte Vista
Address: 4 Chico Camino

Phone Number:
Fax Number:
Monte Vista, CO 81144
(719} 852-2692
(719}852-bi72
If you have additional eommcnts and/or information that should be provided to the Division, please
below or attach it to this form along with your written report and map. Annual Report instru
closed.
1~,,~c.~ 5~.
Signature of Corporate Officer, Owner, or Designee
Date lGU.
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