Laserfiche WebLink
CERTIFICATION <br /> The Applicant, Loveland Ready-AAtx Concrete, Inc. (print applicant/company name), <br /> by Brad Faucher (print representative's name),as President (print <br /> representative's title),does hereby certify that Paul Wagner Residence(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 Dunn Pit (operation name), <br /> File Number M 2021-059. <br /> This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its <br /> authority under the Colorado Land Reclamation AM 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 /> Loveland Ready-MtX <br /> Applicant Concrete, Inc. Representative Name <br /> Date 2--fir Z � _Title President <br /> STATE OF 04 w <br /> )ss. <br /> COUNTY OF ) <br /> The fore ormg was acknowledged before me this(d"day of t by M,U,by ) <br /> as 9 4S\C�AX'kC of � C��(}(Jv:�.�( <br /> QJ(1 b My Commission Expires: <br /> Notao Public <br /> JOAN E HORST <br /> Notary Public <br /> State of Colorado <br /> Notary ID N 19944018967 <br /> My Commission Expires 11-21-2022 <br /> NOTARY FOR STRt1CTtJRE OWNER <br /> ACKNOWLEGED BY. <br /> Structure Owner Name <br /> Date Title <br /> STATE OF ) <br /> ss <br /> COUNTY OF ) <br /> The foregoing was acknowledged before me this day of 20_,by <br /> as of <br /> My Commission Expires- <br /> Notary Public <br />