Laserfiche WebLink
06/14/2015 05:42 9705220867 REESE CONTRACTING PAGE 04 <br />M I Iq 0 051 <br />CERTIFICATION <br />The Applicant, f. i (MOCI (.,LC (print applicant/company name) <br />bY_Ej� weI►e�',�,�� (print representative's name), as I McAmaqvll (print <br />representative's title), does hereby certify that I 11— - Ve4tr` (structure owner) shall <br />be compensated for an dame a fmm the proposed <br />lie g pe r <br />pe Y 13 p posed rn�nin operation to the above listed structure(s) <br />located on or within 200 feet of the proposed affected area described within Exhibit A, of the Reclamation <br />Permit Application for - (operation name), <br />File Number M- 9W -= ��f � <br />This forme has bren approved by the Colorado Mined Land Reclanurtion Board pursuant to ins <br />authority under the Colorado Lard Reclamation Act for the Extraction of Construction Materials and <br />the Colorado Mined Land Reclaina6on Act for Hard Rock, Meter" and Designated Mining Operations, <br />Any alteration or modr; ficadon to this form shall result in voiding this fornt <br />NQIAItY FOR PERMIT APPLICANT <br />ACKNOWLEGED BY: <br />Applicant `7 T Representative Name 2' <br />1 <br />Date 0- —% Title 12"LnMQZ7 <br />STATE OF <br />ss. <br />COUNTY OF, ) <br />The foregoing was acknowledged before me this.Zeday of un D/ 5 by <br />JSG 1 <br />C. tL�_ as h`bn o,. r of Q <br />My Commission Expires: 2_ � .Dr <br />CATHY HENAANN <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />NOTARY Ip 20t44o34$2g <br />CUMO ION EXPIRES 9-4-20is <br />JUN 18 2015 <br />Division ofOft <br />Minino & �y , <br />