Laserfiche WebLink
i <br /> -z- <br /> E <br /> This form has been approved by the Mined Land Reclamation Board pursuant to sections 34-32-119, C.R.S., of the ## <br /> Mined Land Reclamation Act and 34-32.5-119, C.R.S.,of the Colorado Land Reclamation Act for the Extraction of i <br /> Construction Materials. Any alteration or modification of this form shall result in voiding arty permit issued on the <br /> altered or modified form and subject the operator to cease and desist orders and civilpenalties for operating without a <br /> permit pursuant to sections 34-32-123, C.R.S., of the Mined Land Reclamation Act and 34-32.5-123, C.R.S., of the <br /> Colorado Land Reclamation Act for the Extraction of Construction Materials. <br /> Applicant and Successor hereby request the State to consent to the assignment of the approved Permit Application <br /> to recognize the Successor as the approved Applicant under the permitting process. <br /> Donald R Hart Delta County <br /> Name of Permit Applicant Name of Successor Applicant <br /> By , � By <br /> Signature of fficer, Si ature of WE. r l <br /> Titleeoof Officer Title of Officer <br /> NOTARY FOR PERMIT APPLICANT <br /> STATE OF � � ) <br /> SS. <br /> COUNTY OF ) <br /> The forego instrument was acknowledged before me this day of ,by <br /> as owlv6k, of <br /> Iq !q 8D — D Bryn i <br /> ME RI BRITT ` <br /> NOTARY PUBLI6 NOTAR PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20074043379 My Commission expires: <br /> MY COMMISSION EXPIRES DEC.7,2019 <br /> NOTARY FOR SUCCESSOR APPLICANT <br /> STATE OF �� ) <br /> � <br /> js. <br /> COUNTY of <br /> The foregoing instrument was acknowledged before me this day o f�U. 17 by <br /> as allj_LI �'►21,� t �i f <br /> NOTARY—'15VBLIC <br /> ANDRA MENDOZA ' • . <br /> NOTARY PUBLIC My Commission expires: C2rtU � <br /> STATE OF COLORADO <br /> NOTARY ID#20154047342 <br /> My Commission Expires December 9,2019 <br />