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~~ ~ R~~' <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />/~ <br />Grand County / <br />M-1995-004 l/ <br />Inspiration Point <br />E+~-`,__ ~~r <br />~`.T <br />APR 1 ~ 2008 ~ <br />~li+t'su~ ni~~ ~.~vi'~ <br />May 5, 2008 <br />$$791.00 (Due on or before your anniversary date) <br />Grand <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 <br />_ - oper-ator shall-submit the annual fee, a report and map -showing the extent of current distur-bances-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 your revised written annual report and annual report map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred durinE the previous year and no <br />new chanEes to the previous year's map are necessary, then no new map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Ken Haynes <br />Permittee Name: Grand County <br />Address: 467 E. Topaz Ave. <br />P.O. BOX 9 <br />Granby, CO 80446 <br />Phone Number: (970) 887-2123 <br />Fax Number: (970) 887-3168 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or ttach it this form along with your written report and map. Annual Report instructions are <br />enclose . <br />Signature of Corpora O icer, Owner, or Designee <br />b~ 1 ~ -~d' <br />Date <br />M:~PERMI'IIMASTERDOCUMENTS~IvI-AF-04 <br />