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~ ~ <br />~' ~ ~ 1 <br />ANNUAL FEE and REPORT REQUEST <br />,:.~ <br />PERMITTEE NAME: Don Kehn Construction, Inc. <br />PERMIT NO.: SVI-1989-056 ~~~~~ ~ ~ L~~~ <br />OPERATION NAME: Timnath Pit ~~ ~ ~ ~ ~ ~ ` `'on' <br />~!'~fth1~ hi.:. JC.G.y <br />ANNIVERSARY DATE: February 24, 2007 <br />ANNUAL FEE DUE: $$688.00 (Due on or before your anniversary date) <br />COUNTY: Latimer <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 permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />__ reclamation accomplished to_date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the 6eginnii9g <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, resort, and associated <br />map. If no new disturbances or reclamation have occurred durinc the previous vear and no new chances to <br />the nrevious year's man are necessary. then no new man is required, provided that the Operator shall state <br />this in the Annnal Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Don Kehn <br />Permittee Name: Don Kehn Construction, Inc. <br />Address: 6550 S. CR 5 <br />Fort Collins, CO 80528 <br />Phone Number: (970) 226-4111 <br />Fax Number: (970) 226-4115 <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 enclosed. <br />~CLe..-~ <br />Signature of Corporate Officer, Owner, or Designee <br />~- ~O~ ~~ <br />Date <br />