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-z - <br /> This fora► has been approved by the Mired Land Reclamation Boa►•d pr►rsrrant to sections 34-32-119, C.R.S., of the <br /> Mined Land Reclamation Act and 34-32.5-119, C.R.S., of the Colorado Land Reclamation Act for the Extraction of <br /> Construction Materials. Any alteration or modification of this form shall result in voiding any permit issued oil the <br /> altered or modified form and subject the operator to cease and desist orders and civilpenalties for operating►vithout a <br /> permit pursuant to sections 34-32-123, C.R.S., of the Mined Land Reclamation Act and 34-32.5-123, C.R.S., of the <br /> Colorado Land Reclamation Act for the Extraction of Construction Materials. <br /> Applicant and Successor hereby request the State to consent to the assignment of the approved Permit Application <br /> to recognize the Successor as the approved Applicant under the permitting process. <br /> J"T--M n r1•(S CZ---.%-Tnj (-4 r re-k+ tkZa- <br /> or Applicant �— <br /> By By <br /> 6g� ic�N'4 <br /> Sia(at Officer Signature of Officer <br /> �pcc� P.1 �' \-,." 4,r06--� <br /> Title of Officer Title of Officer <br /> NOTARY FOR PERMIT APPLICANT <br /> STATE OF <br /> !� )ss. <br /> COUNTY OF <br /> The foregoing instrument was acknowledged before me thisldaOy of f �� by of <br /> as 1C <br /> ANGELA MURPHY <br /> NOTARY PUBLIC NOTARY BLIC / <br /> STATE OF COLORADO <br /> NOTARY ID 2017402444S n <br /> My Commission Expires 064)9-2021 My Commission expires: (f <br /> NOTARY FOR SUCCESSOR APPLICANT <br /> STATE OF <br /> ss. <br /> COUNTY OF � ) <br /> S L n <br /> The foregoing instrument was acknowledged before me this day of 6rV-a , o�cal ,by <br /> SZ as of <br /> NOTARY PVBfIC <br /> CHERRYLYN VILLENA I a �C%) <br /> NOTARY pUBL�C My Commission expires: <br /> STATE OF COLORADO <br /> y COMM- ID 20184005170 <br /> MY Commission Expires o1-31-2022 <br />