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r <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 <br /> and the Colorado Mined Land Reclamation Act for Hard Rock,Metal,and Designated Mining <br /> Operations. Any alternation or modification of this form shall result in voiding this or <br /> Applicant: Hall-Irwin Aggregates,LLC By:= _ <br /> Bret Hall,Manage <br /> Da 2017 <br /> NOTARY FOR PERMIT APPLICANT <br /> STATE OF COLORADO } <br /> ) <br /> COUNTY OF WELD ) <br /> The foregoing was acknowledged before me this�btay, 2 17,by Bret Hall as <br /> Manager of Hall-Irwin Ag r f ,LLC,the Applicant. <br /> DONNA M KRAFT <br /> Notary Public <br /> St pf Colorado Notary Public <br /> M -�O�r #f 199 49ifIS 59 rY <br /> [ ggitgsp -2020 <br /> SIGNATURE OF STRUCTURE OW sR <br /> Structure Owner: KIM R&SUSAN LAWRENCE Signature: <br /> Date: Title: <br /> NOTARY FOR STRUCTURE OWNER <br /> STATE OF COLORADO ) <br /> ) <br /> COUNTY OF WELD ) <br /> Thhe foregoing was acknowledged before me this day of ��"�� 2017,by <br /> 1(�rr��h• -G�u1�f�,Y1Ce, a� . St�SQr1 I-1AA)OACC of <br /> (seal) Notary Public <br /> My Commission expires:... /5 '20—V <br /> AUTUMN L PENFOLD <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20014022034 <br /> MY COMMISSION EXPIRES AUGUST 15,2021 <br />