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/Y <br /> • III IIIIIIIII IIII III • <br /> 999 <br /> ANWAL FEE and REPORT REOUEST <br /> PERMITTEE NAME: Park County <br /> PERMIT NO.: M-1"7-035 JUN 2 a 2QQ� <br /> OPERATION NAME: Chaparral Pit 2 [nesals and Ga91ogV <br /> Division otM <br /> ANNIVERSARY DATE:July 21,2001 <br /> ANNUAL FEE: $281.00 (Due on or before anniversary date) <br /> COUNTY: Park <br /> According to C.R.S. 34-32.5 or C.R.S. 34-32-116, each year. On the anniversary date of <br /> the permit,an operator shall submit the annual fee,a report and map showing the extent <br /> of current disturbances to affected land,reclamation accomplished to date and during the <br /> preceding year,new disturbances that are anticipated to occur during the upcoming year, <br /> the dates for the beginning of active operations, and the date active operations ceased for <br /> the year, if any. <br /> Please attach your revised written annual report and annual report man to this <br /> form.Please note that an adequately labeled map that clearly delineates and includes <br /> the above elements may suffice for a written report. <br /> Division records indicate the following permittee contact information. Please verify and <br /> make any necessary changes: / <br /> Permittee Contact: -I)D[JEs Yet:11-F* <br /> Permittee Name: AFZ4 AI <br /> Address: O 'e>o C <br /> FAA IzI Cc, D <br /> Phone Number: 7t7 <br /> Fax Number: 7/q e3(e - 75 <br /> If you have additional comments and/or information that should be provided to the <br /> Division, please provide it below or attach it to this form along with your written report <br /> and Annual R ions are enclosed. <br /> a= <br /> Signature o Cot!oratdf Officer or Owner <br /> Date <br />