Laserfiche WebLink
CERTIFICATION <br /> The Applicant, Western Slope Materials LLC, by Sean Mello, as General Manager, does <br /> hereby certify that (,,� s r a�.� S,,, € wtsi ,,—���c s < < <(structure owner) shall be <br /> compensated for any damage from the proposed mining operation to the above listed <br /> structure(s) located on or within 200 feet of the proposed affected area described within <br /> Exhibit A, of the Reclamation Permit Application for Blue Pit, File Number M-1981-207. <br /> This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its authority <br /> under the Colorado Land Reclamation Act for the Extraction of Construction Materials and the Colorado <br /> Mined Land Reclamation Act for Hard Rock, Metal, and Designated Mining Operations.Any alteration or <br /> modification to this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: <br /> rJ'c <br /> Applican"f c-Representative Name �- <br /> Date I ( (to Title �-n <br /> s1.` ��.� Pt r..Lr A_ <br /> STATE OF C��m,� ) TIMOTHY OLK <br /> Notary Public <br /> ss. State of Colorado <br /> COUNTY OF Cr4rf��I ) Notary ID#20164038408 <br /> My Commission Expires 10-06-2020 <br /> The foregoing was acknowledged before me this , 2 ,c If. by <br /> S�,-J WttL,o as CTtN_TrLh,_ MajA. Hof c1��sr�.L &_� _S ..j�4' My4gV44Ls 4- LC_ <br /> 1 /__� My Commission Expires: D/G 20 <br /> Notary Public <br />