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i rill 1 :v <br />u.� Clerk and Recorder <br />Katie Barr - Fremont County Clerk & Recorder <br />615. Macon Avenue, Room 102, Canon City, Colorado 81212 <br />Phone 719 - 276 -7330 Fax 719 - 276 -7338 <br />RE: MINING RECLAMATION PERMIT APPLICATION <br />COLO STAT. 34 -32- 112.10.8 <br />DATE RECEIVED <br />NAME OF APPLICAN�� C'I� O U C <br />V <br />PERMIT # <br />o�t7 <br />DATE OF HEARING <br />NAME OF CONTACT PERSON T- <br />PHONE NUMBER Q-_7 S - a 0 <br />Please check which applies to your permit: <br />I wish to be contacted 30 days after the hearing to pickup the application <br />I do not wish to pick up the application 30 days after the hearing and hereby give the Clerk's <br />Office permission to destroy <br />Signature <br />Date of Disposition <br />Clerk <br />