Laserfiche WebLink
CERTIFICATION <br /> The Applicant, Premier Moss Rock, LLC (print applicant/company name), <br /> by Nick Simpson (print representative's name), as General Manager (print <br /> representative's title), does hereby certify that Premier Moss Rock, LLC (structure owner) shall <br /> be compensated for any damage from the proposed mining operation to the above listed structure(s) <br /> located on or within 200 feet of the proposed affected area described within Exhibit A, of the Reclamation <br /> Permit Application for Colorado Moss Rock (operation name), <br /> File Number M-2011-039. <br /> This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its <br /> authority under the Colorado Land Reclamation Act for the Extraction of Construction Materials and <br /> the Colorado Mined Land Reclamation Act for Hard Rock,Metal, and Designated Mining Operations. <br /> Any alteration or modification to this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: // � � <br /> Applicant w H Ixk, 6Lc Representative Name Ai ,.)/jutiosan <br /> Date Au-el. 31, Z.o Lo Title Ci t-'a. <br /> STATE OF 1 + N ) ^' JENNY CHRISTINE HETLAND <br /> ) ss. !L NOTARY PUBLIC-MINNESOTA <br /> COUNTY OF NY\O V-401/4— ) MY COMMISSION EXPIRES 01/31/2025 <br /> The foregoing was acknowledged before me this 31 day of Mc Lr'C.1-. , 20A0,by <br /> NI i Gholas S1wySo- as _,YexctA I.A of Yre.m:P�- MOSS �x }.Lf� <br /> OU <br /> 4/ / Lj4' t I09 My Commission Expires: �j 1 I L0 a5 <br /> Nry Publ <br />