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~m' \ <br /> O <br /> ANNUAL FEL an P <br />RT REQUEST <br /> <br />PERMITTEE NAME: <br />'The Clare Corporation ~?`~aG~ ~~,~N~ <br />~ ._ , <br />PERMIT NO.: ~vi-1989-044 ~'R 2 .~ 2008 <br />OPERATION NAME: Twin Crk Campground ~i seen ct ,-.. ;.., <br />, _ <br />ANNIVERSARY DATE: April 10, 2008 , <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Teller <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 beginning <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, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new chanEes to <br />the previous year's_ map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual 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: Harold E. Clare, II <br />Permittee Name: The Clare Corporation <br />Address: P.O. Box 1 <br />Florissant, CO 80816 <br />Phone Number: (719) 748-3805 <br />Fax Number: (719) 748-5120 <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 />Signature of Corporate Officer, Owner, or Designee <br />~'/ ~ ~ /~ ~ <br />Date <br />