Laserfiche WebLink
REr=j <br /> CERTIFICATION MAY 2 D 2016 <br /> pp Bent County a'VISIO OF <br /> The A licant, (print applicapt�� �J <br /> by Bill Long (print representative's name), as Commissioner (print <br /> representative's title), does hereby certify that Bob & Ronda Bucholz (structure owner) shall <br /> be compensated for any damage from the proposed mining 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 Thomeczek Pit (operation name), <br /> File Number M-1995-007 <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 and <br /> lire Colorado Mined Land Reclamation Act for Hard Rock, Metal, and Designated Mining Operations. <br /> Any alteration or modification to this form shall result in voiding this farm. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: o p <br /> Applicant [3±=,ti T-C Representative Name <br /> Date_ � ci Title C'cwr okXXX ONE R <br /> STATE OF U O mdo ) <br /> )ss. <br /> COUNTY OF_&-jj .__ ) <br /> � M <br /> The foregoing was acknowledged before me this day of ' , 2016, by <br /> as of <br /> n GVIvi Jv My Commission Expires: r <br /> Notary Public <br /> SHAVEN LYN BRANCH <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY 10 t 20004008321 <br /> _MY COMMISSION EXPIRES MAY 2 ec <br />