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7V D 1S <br />r <br />ANN PAL FEE and REPORT REQUEST <br />PERMITTEE NAME: ?y Kit Carson County <br />PERMIT NO.: vm_1989-003 <br />OPERATION NAME: Raymond Schulte Pit <br />ANNIVERSARY DATE: April 5, 2009 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Kit Carson <br />Y10 <br />- -- According to .G.R.S._-3.4-32..5-116 or.C_R.S_ 3-4-32_116,. each_year,._on_the anniversary date _f the_permit, an <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 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 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: Carol A. Fritz <br />Permittee Name: Kit Carson County <br />Address: 251 16th Street, Suite 201 <br />P.O. Box 160 <br />Burlington, CO 80807 <br />Phone Number: (719) 346-8139 <br />Fax Number: (719) 346-7242 <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 />u '? <br />e of Corp Officer, Owner, or Designee <br />DID <br />-Ik-O9 <br />Date <br />M:IPERMITIMAS TERDOCUMENTS\M-AF-04