2009-09-09_REPORT - M1986124 - Laserfiche WebLink

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PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNIVERSARY DATE: ANNUAL FEE DUE: COUNTY: ,j R?-r ANNUAL FEE and REPORT REQUEST Donald G. Popejoy V/D-1986-124 Cecil II Gravel Pit October 24, 2009 RECEFVZD S P 2,009 $$323.00 (Due on or before your anniversary date) Washington 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 shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, turbances that are anticipated to occur reclamation accomplistled-tu date rd a 91. during the upcoming year, reclamation that will be performed during the coming year, the?ates for the beginning-- -- - of active operations, and the date active operations ceased for the year, if any. Please attach vour revised written annual report and annual report map to this form. The Annual Report & Fee requirement is not met until we have received the following components: fee, report, and associated map. If no new disturbances or reclamation have occurred during the previous year and no new changes to the previous vear's map are necessary, then no new map is required, provided that the Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. Division records indicate the following permittee contact information. Please verify and make any necessary changes: Permittee Contact: Donald G. Popejoy Permittee Name: Donald G. Popejoy Address: 7645 Mulberry Lane Naples, FL 34114 Phone Number: (239) 775-9617 Fax Number: t L Q -) m? !7 Z i ?& If you have additional comments and/or information that should be provided to the Division, please provide it below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. Signature of tCoorA Of cer, Owner, or Designee D e