2011-01-26_REPORT - M1992003

• Permit No: M1992003
• IBM Index Class Name: REPORT
• Doc Date: 1/26/2011
• Doc Name: Annual Fee/Report/Map
• From: Silver Mtn.
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
,
ANA FEE qanREPORT REQUEST
Silver Mountain Preserve, Inc.
VM-1992-003
Willis Pit
February 7, 2011
$323.00 (Due on or before your anniversary date)
Huerfano

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,
- --- reclamation-accomplished--toAate a doming-the-preceding Year, -new-disturbance-s-that are antiialipated to-occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach your 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 year's map are necessary, then no new may 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: Travis R. Crawford
Permittee Name: Silver Mountain Preserve, Inc.
Address: 11850 CR 520
La Veta, CO 81055
Phone Number: [phone]
Fax Number: [phone]
no change
no change
no change
no change
no change
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.
• ?t? -0? There has been no activity during the
Signature of Corporate Officer, Owner, esignee previous year.
/--- / 9`- - / /
Date