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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />)&-Oaklands Ranch <br />-1989-092 <br />Oaklands Ranch <br />P---- <br />SEP 2 <br />October 26, 2010 n1v6dion od t")';h'Mtluw, <br />$$791.00 (Due on or before your anniversary date) <br />Douglas <br />AccordingtoC.R.S. 34-32.5-116 or C_R.S_34-32-116,_each year, on the aniversary-date -the-perm ti,. o operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />--- reclamation-accomplished-to-date--and-durmg#he-preceding-3war,_new- _disturbanoes_._that are. anticipated_to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations; and the date active operations ceased for the year, if any. <br />Please attach vogn revised written annual report and annual report man to this form.. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous year's map are necessary, then no'new may is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: David Curtis <br />Permittee Name: Oaklands Ranch <br />Address: 1613 N Perry Park Rd <br />Phone Number: <br />Fax Number: <br />Sedalia, CO 80135-8511 <br />(303) 688-4285 <br />(303) 688-7957 <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 enclosed. <br />Si a of Corporate Officer, Owner, or Designee <br />0 Ila <br />Date