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 6f 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 Extraction of Construction Materials and the Colorado Mined Land <br /> Reclamation Act for Hard Rock, Metal, and Designated Mining Operations.Any alteration or modification to <br /> this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: <br /> OI�C0.3t1.2,S11J C�+�uQ����'dbA j <br /> Applicant'e c� F_XCCL.(�,-�nca Representative Name'- �° <br /> 1 , / <br /> Date l �1'1 0� Title V ) <br /> STATE OF <br /> ss. <br /> COUNTY OF <br /> The foregoing was acknowledged before me this/f-//Iday of,1 �Fr , 20_�L, by <br /> as G,CE of <br /> My Commission Expires: ; <br /> Notary Public <br /> GENEVIEVE M.BLECHA <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID#19914003259 <br /> My Commission Expires April 4,2019 <br /> w�\v" <br /> W <br />