Laserfiche WebLink
• 5 T�Ct,lGtc,l�2� ��j lit 7 � lOpt 4"113 <br /> CERTIFICATION <br /> San Miguel County Colorado <br /> The Applicant, (print applicant/company name), <br /> by Lynn Black (print representative's name),as Cnunfy AdminictratAr (print <br /> representative's title),does hereby certify thatpw i,c Service.CQ. Qf.Col orA6tructure 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 Pathfinder Pit (operation name), <br /> File Number M- 1994 113 <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 /> the 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 form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: <br /> Applicant San Miguel County, CO. Representative Name Lynn Black <br /> Date 10/5/2016 Title County Administrator <br /> STATE OF Cn1 nrado ) <br /> )ss. <br /> COUNTY OFSan Miguel ) <br /> T4 foregoing was acknowledged before me this 5 day of 6elhoU Y , 20/b,by <br /> t?Pt r d as of Oa.r? Mt' ti 0 4 C <br /> ✓ r�r� 40-K j 4in4 .0 uv✓" COrnrni561 anew <br /> My Commission Expires: °y-a( <br /> otary Public <br /> REC�,vEQ CARMNotary pubic LYNAFIELD <br /> state of Colorado <br /> 2G16 Notary ID 20164015831 <br /> M <br /> NOv Q y Commission Expires Apr 26,2020 <br /> o{Rec1a{ty,on, <br /> viv�s�On &Sa <br /> 3 <br />