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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~~ r <br />• L/ogan County -`+' <br />vM-1995-063 <br />Schumacher Pit <br />September 15, 2005 <br />~' S <br />fO <br />$281.00 (Due on or before your anniversary date) <br />Logan <br />___ According, to CR.S. 34-325_116 or C.R.S._ 34-32-116_each_year, on the anniversary date of the permit, an _ _ <br />operator shall submit the annual fee, a report and 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 anm~al rennrt and annnal rep nn rf matn fo this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following pennittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Byron D. Hickox <br />Permittee Name: <br />Address: <br />Logan County <br />315 Main St., Ste. 2 <br />Sterling, CO 80751 <br />Phone Number: (970) 522-7879 <br />Fax Number: (970) 522-4018 <br />ooS~~r. ~ ~ IllG~brm~`CK <br />If 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 along with your written report and map. Annual Report instructions are <br />enclosed. <br />c <br />Signature orp rate Officer, Owner, or Designee <br />q-~-CAS <br />Date <br />M:~PERMI7~MASTERDOCUMENTSNI-AF-04 <br />