Laserfiche WebLink
r_ • <br /> CERTIFICATION <br /> The Applicant, HUERFANO COUNTY GOVERNMENT(print applicant/company name),by <br /> (print representative's name),as <br /> (print representative's title),does hereby certify that CITY OF WALSENBURG (structure owner)shall be <br /> compensated for any damage from the proposed mining operation to the above listed structure(s)located on <br /> or within 200 feet of the proposed affected area described within Exhibit A, of the Reclamation Permit <br /> Application for LONE TREE GRAVEL PIT(operation name), <br /> This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its <br /> authority under the Colorado Land Reclamation Act for the Extraction of Construction Materials <br /> and the Colorado Mined Land Reclamation Act for Hard Rock,Metal,and Designated Mining <br /> Operations <br /> Any alteration or modification to this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEDGED BY: <br /> Applicant HUERFANO COUNTY GOVERNMENT <br /> Representative e I 'f S, ed6 i-fi, <br /> Signed: .� ! — Date 7/23/y Title ���c.��•o.� 4v CL <br /> Rep - -ntative Name 11/-4?.s s, <br /> Signed: Dateile pifitlee fuei` <br /> Representative ame <br /> Signed: Date Title <br /> STATE OF Colorado ) NOTARY PiJB IC <br /> )ss. STATE OF COLORADO <br /> COUNTY OF Huerf ano ) NOTARY ID 19954014899 <br /> MY COMMISSION EXPIRES SEPTEMBER 29.2015 <br /> The foregoing was acknowledged before me this 23 day of April ,20 14,by <br /> td.r) 12 e a_ ,• .....+r. ��tl t.:.r ivaguerf ano County <br /> ' ff:QNotary Public N' ld.Q, '' My Commission Expires: 9/29/15 <br /> NOTARY FOR STRUCTURE OWNER <br /> ACKNOWLEDGED BY: <br /> Structure Owners: CITY OF WALSENBURG <br /> Representative N (S)f e,S i'fc J e r- <br /> Signed: <br /> Date 1///6/10,y Title WANDA A. BRITT <br /> STATE OF edi ra.a/o ) NOTARY PUBLIC <br /> STATE OF COLORADO <br /> I )ss. NOTARY ID 201140080:'1 <br /> COUNTY OF/herp4o ) MY COMMISSION EXPIRES 02%••;42015 <br /> The foregoing was acknowledged before me this / ay ofd ,20 by <br /> ,�// of � ` l'�'a'LISel <br /> •Notary Public s..fitieRie- My Commission Expires:QZ/03/Zo!_'5 <br />