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ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: N Colo Water Conservanc Dist. ~i~ ~~~~~~ <br />y <br />PERMIT NO.: M-1981-086 /~ [~ ~~~ I ~ ~ooq <br />OPERATION NAME: Borrow Area C ~ ~'~g c+ n.ecamatio,~s, <br />~/ M'n'r-9 and Safety <br />ANNNERSARY DATE: July 21, 2009 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Grand <br />- ==~eec~rding=tom-GRS~4_3~5~1=I6~or-G ~:5~~-311--3?~=1~ - a anni~ver-~~y_-date-_ef-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 man 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 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: Jim Struble <br />Permittee Name: N Colo Water Conservancy Dist. <br />Address: 220 Water Avenue <br />- _ `- ~ ~-"^BerEhoud; CO 80513 - - ~ - ^~ <br />Phone Number: <br />Fax Number: <br />(970)532-7700 <br />(970) 532-0942 <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 />encl se . <br />.. <br />Si to of Co r icer, Owner, or Designee <br />lam/ ~/~~i`' <br />Date <br />M:IPERMIT~MASTERDOCUMENTSIM-AF-04 <br />