Laserfiche WebLink
S48 <br />CERTIFICATION <br />The Applicant, Turkey Cation Quarry Inc., byM wz ti r as t�Z�'sJ�------; does hereby certify <br />that JAMES T OR JANICE M SCHLIEPER (structure owners) shall be compensated <br />for any damage from the proposed mining operation to the above listed struclure(s) located within 200 feet of the <br />proposed affected area described within Exhibit A, of the Reclamation Permit for Vollmer Pit, <br />File Number M-1983-035. <br />Signature ofApplica —\—.', �. <br />71is fornr has been approved by the Colorado Mined Land Reclamation Board pursttant to its authority <br />under the Colorado Land Reclamation Act for the Extraction of 'Construction Materials and the Colorado Mitred <br />Land Reclamation Act for Hard Rock, Metal, and Designated Miming Operations. Any alteration or modification to <br />this form shall result in voiding this form. <br />NOTARY FOR PERMIT APPLICANT <br />ACKNOW LEGED BY: <br />Applicant: law L{fN04 Qq .4L Representative Name: Kwa iy1 L " <br />(Please print) (Please print) <br />Date: _ 01/1-A-10be - ?A <br />STATE OF COLORADO ) <br />) ss. <br />COUNTY OF El PASO ) <br />Title: Vi ci Q-"0� <br />The foregoing was acknowledged before me this ' A day of DMO-- , 2018, by <br />- as VL(.6 of GAVDoDdd,AltB I�j,NG. <br />(si ture of owner or representative) (title) (company name) <br />My Commission Expires:MOA-Jo !���- <br />Notary Public Signature <br />ERIC S HOWARD <br />Notary Public <br />State of Colorado <br />Notery lID # 20144021884 <br />My Commission Ex ires.05-30-2022 <br />Page 2 of 3 <br />