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Clerk and Recorder <br /> FEB 2 0 2018 <br /> �P Katie E. Barr, County Clerk & Recorder FREMONT COUNTY <br /> 615 Macon Avenue, Room 102 Canon City, Colorado §�Tfj RECORDER <br /> Phone 719.276.7330 <br /> Fax 719.276.7338 <br /> katie.harr@fremontco.coin <br /> RE: MINING RECLATMATION PERMIT <br /> APPLICATION COLO STATE 34-32-112.10.8 <br /> DATE RECEIVED 04 () JaQl(k/ <br /> NAME OF APPLICANT -Fevy-,04 0 <br /> PERMIT <br /> DATE OF HEARING <br /> NAME OF CONTACT PERSON: <br /> l Ians+�— C0eQ phone <br /> please print <br /> Please check which box applies to your permit: <br /> Z, wish to be contacted 30 days after the hearing to pickup the application <br /> I do not wish to pickup the application 30 days after the hearing and <br /> herby give the clerk's permission to destroy <br /> i <br /> Signature t aLiLt <br /> • Date of Disposition NIA- Clem � CL <br /> 3/2/2016 V:UANTormsVeclamation form.doc <br />