2004-04-30_REPORT - M1995004

• Permit No: M1995004
• IBM Index Class Name: Report
• Doc Date: 4/30/2004
• Doc Name: Annual Fee/Report/Map
• From: Grand County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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I I
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Graud Couuty
M-1995-004
Inspiration Point
May 5, 2004

APR 3 0 2004
Division of Minerals & Geology
$688.00 (Due on or before your anniversary date)
Grand
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-aceomplished-to-date_and-during.khe preceding vear,_new_disturbances that_are_anticipated to _ i _
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 the year, if any.
Please attach ynnr revised written anm~al re_pnrf and annnal reAnrt maw to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a u7itten
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: M C. Branstetter
Permittee Name: Grand County
Address: 467 E. Topaz Ave. ;'
P.O. Box 9
Granby, CO 80446
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.
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Signature of Corporate Officer, Owner, or Designee
/lag/d~
Date l
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