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~~ ~~~ ~ ' <br />PERMITTEE NAME: <br />PERMIT NO,: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />S//edgwick County <br />vM-1996-073 <br />Dolezal Gravel Pit <br />November 8, 2005 <br />RECEIVED <br />~OV 0 8' 2005 <br />.~ <br />~ Division of Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Sedgwick <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 hermit, an ^ _ <br />opera or s a su m~ e-annual' Feee;=a~reporY aiid-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 ynnr revised written anmral report and annnal re~prt. mAr}n this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may su~~e for a written <br />report. <br />~. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Randy Renquist <br />Permittee Name: Sedgwick County <br />Address: 223 S. Cedar <br /> Julesburg, CO 80737 <br />Phone Number: (970) 474-3576 - -- --- <br />Fax Number: (970) 474-3558 <br />1f 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 alorig with your written report and map. Annual Report instructions are <br />enclosed. <br />Si-~ orate Officer Owner or Desi ee <br />>~ rP ~ <br />f©~ ~! o~ <br />Dale <br />MiPERMITNIASTERDOCUMENTSwt-AF-04 <br />