Laserfiche WebLink
Af s,-, pr <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Rio Blanco County <br />PERMIT NO.: M-1995-046 <br />OPERATION NAME: Johnson Draw <br />ANNIVERSARY DATE: October 7, 2008 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Rio Blanco <br /> <br />OCT S 0.2003 _, <br />11' ag rp cry s? 2y L <br />-- - --?-ecording-ta-E:R:S-34-323--1-1.6-er--E:Ii.S:---?4-?1_k6?e?cl?-?n-thP aa?ivexsa?3date ?f thQ??mit,v *+ <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances 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 vour 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 may. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous vear's map are necessarv. 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: <br />Permittee Name: <br />Address <br />Ron Leeper <br />Rio Blanco County <br />570 2nd St. <br />Meeker, CO 81641 <br />Phone Number: (970) 878-9590 <br />Fax Number: (970) 878-3396 <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 <br />enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />q. -->.-%--oF1 <br />Date <br />M: PERMITIMASTERDOCUMENTS\M-AF-04