Laserfiche WebLink
CERTIFICATION <br /> The Applicant, Oldcastle SW Group, Inc. dba B&B Excavating, by Pete Siegmund, as <br /> Assistant Secretary, does hereby certify that �L�(structure <br /> owner) shall be compensated for any damage from the proposed mining operation to the <br /> above listed structure(s) located on or within 200 feet of the proposed affected area described <br /> within Exhibit A, of the Reclamation Permit Application for Carol Ann Pit, File Number M- <br /> 1997-026. <br /> This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its authority under <br /> the Colorado Land Reclamation Act for the E.rtraction of Construction Alaterials and the Colorado Alined Land <br /> Reclamation Act for Hard Rock, Metal, and Designated ruining Operations AnY alteration or modification to <br /> this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: <br /> oil Cl�.'�tlsZ 5u-) (otbv+-) (nc- . <br /> ApplicantA-ho, Zth Ex c�,,jati r7a Representative Name r�f� <br /> i <br /> Date S�,A�Y\VV o Title I C ( {it <br /> STATE OF <br /> ss. <br /> COUNTY OF <br /> The foregoing was acknowledged before me this /P'�day of 1t��1��� 20/ , by <br /> J, as Vr`t,-- �r�5��a1� of G/��ou� 1.�c_ <br /> My Commission Expires: <br /> Notary Public <br /> [GE7NEVIEVEI.BLECHA <br /> UBLIC <br /> LORADO914003259 <br /> res April 4,2019 <br />