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1`1?1 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />a1 I <br />ANNUAL E and ltd; REQUEST <br />/City of Cripple Creek <br />c-M-1993-039 <br />Midland Gravel Pit <br />August 4, 2008 <br />RE C-11 <br />--JUL 212008 <br />/Division or rtecicmation, <br />Mining and Safety <br />$$323.00 (Due on or before your anniversary date) <br />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 <br />- -operator -shall- submit the-annual -fee;-a-report-arid=map sh6Nving`the-extent-oi'-eurrent-disturbarees-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 />\Ij Please attach our revised written annual report and annual report ma to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated man. If no new disturbances or reclamation have occurred during the Previous year and no <br />new changes 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 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: Chip Huffinan <br />Permittee Name: City of Cripple Creek <br />Address: <br />Phone Number: <br />Fax Number: <br />If you have .ihc <br />below o attach it <br />Date <br />337 E. Bennett Ave. <br />P.O. Box 430 <br />_ Cripple Creek, CO 80813 <br />(719) 689-2125 <br />(719) 689-0121 <br />comments and/or information that should be provided to the Division, please provide it <br />this form <br />,Along with your written report and map. Annual Report instructions are <br />Officer, Owner, or Designee <br />pN l< O/C <br />M:\PERMIT \MASTERDOCUMENTS\M-AF-04