2015-01-06_PERMIT FILE - M2014066

• Permit No: M2014066
• IBM Index Class Name: PERMIT FILE
• Doc Date: 1/6/2015
• Doc Name: Incompleteness Response
• From: Wesley Williams
• To: DRMS
• Email Name: MAC
• Media Type: D
• Archive: No

01/06/2015 12:57 FAX [phone] UPS-STORE-6469 Q008/009
The
int representative's name), as
applicant/company name),
r jr
representatieve'strtle), does hereby certify that �i _(structure owner) shall
be compensated for any damage from the proposed mining operation to the above listed structure(s)
located on or within 200 feet of the proposed affected area described within Exhibit A, of the Reclamation
Permit Application for a .�' lj/, XiIL*ea1-5APAI (operation name),
File Number M- & -jal-fi.
This form has been approved by tit Colorado Mined Land Reclamation Board pursuant to in
authority under the Colorado Land Reclamation Act for the A�dractlon of Construction Materials and
the Colorado Mined Land Reclamation Act for Hard Rock, Metal and Designated Mining Operations.
Any aJteradfon or modification to this farm shall result in voiding this form.
ACKNOWLEGED BY:
Applicant tuaAoiyj Ur,C LJ—C Representative Name ��s1e4 ,
A11 n u1i tams
Date es' 19, Title
STATE OF W 1A )
) ss.
COUNTY OF )
`Flr
The foregoing was acknowledged before me this day ofd mbet- , )A I by
of �hCWM . L LC.
de-;ad.V4IA'- *
•� My Commission Expires:_
Notary Public
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