2006-08-22_REPORT - M1983130

• Permit No: M1983130
• IBM Index Class Name: Report
• Doc Date: 8/22/2006
• Doc Name: Annual Fee/Report/Map
• From: Elbert County
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
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,/ ANNUAL FEE and REPORT REQUEST
'~ Elbert County
r/M-1983-130
West Pit
September 22, 2006
RECEIVED
Luc z 2 zoos
t~pivision ota d S ( Y n,
Mining
$281.00 (Due on or before your anniversary date)
Elbert
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 accomplished to date and during the preceding year, new disturbances that are anticipated to
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 vour revised written annual report and annual report man to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact:
Permittee Name:
Address:
Phone Number:
Fax Number:
Marilyn Sproch
Elbert County
809 Ute Ave.
Simla, CO 80835
[phone]
[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 inshucfions are enclosed.
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Signature of Corp9 •ate Offic i, Owner, signee
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Date
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