Laserfiche WebLink
�n <br />CERTIFICATION <br />The Applicant, Turkey Carton Quarry Inc., by M Ax y, nn �+ ,_ �- d � as Sep C.6- A%—;,.—does hereby certify <br />that NORMAN C OR THREASE {MOOD (structure owners) shall be compensated <br />for any damage from the proposed raining operation to the above listed structure(s) located within 200 feet of the <br />proposed affected area described within Exhibit A, of the Reclamation Pem-di for Vollmer Pit, <br />File Number M-1983-035. <br />Signature ofApplica <br />7hisfornn has been approved by the Colorado Mined Land Reclamation Board pursuant 10 its authority <br />under the Colorado Land Reclamation Act for the Extraction of Construction Materials and the Colorado abutted <br />_ Land Reclamation Aer for Hard Rack, Metal, and Desigtrated Muting Operations.. 4r0, alteration or modifrcation to <br />this form shall result in voiding this form. <br />NOTARY FOR PERMIT APPLICANT <br />ACKNOWLEGED BY: <br />Applicant: law 014 J Representative Name: M& mw, r V. �. <br />(Please print) (Please print) <br />Date: Oc*OWL q - 2v L <br />STATE OF COLORADO ) <br />) ss. <br />COUNTY OF EI PASO ) <br />Title: Vici K&00 <br />The foregoing was acknowledged before me this q_% day of DMS , 2018, by <br />NA4i Mme' •f as.. UtCj 44COYAS of �i ('kuDo WAW I "�uG <br />(s- tureof owner or represen tine) (title) (company name) <br />My Commission Expires: MfikA 3a 1741M— <br />Notary Public Signature <br />ERIC S HOWARD <br />Notary Public <br />Stag of Colorado <br />Notary 1D N 20144021884 <br />NIX Commission Ex fres 05-30.2024 <br />Page 2 of 3 <br />