Laserfiche WebLink
CERTIFICATION <br /> The Applicant, IHC Scott, Inc. (print applicant/company name), <br /> by s.. a►�.✓�Z (print representative's name), as ,C p/�3 hAl�- (print <br /> representative's title), does hereby certify that White River Electric Association(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 Collett Property Borrow Area (operation name), <br /> File Number M-lalz- brl. <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 IHC Scott, Inc. Representative Name <br /> Date l(S('13 Title qa( Qnh dc,—k-- <br /> STATE OF cJl ) <br /> ss. <br /> COUNTY OF ) <br /> The foregoing was acknowledged before me this day of - , 2075, by <br /> '(&y�.t (2A;-*i as V of IHC Scott,Inc. <br /> p�CQ My Commission Expires: s��� GJ <br /> Notat Pub is <br /> MITZI REECE <br /> Notary Public <br /> State of Colorado <br /> Notary ID 0 20184011940 <br /> My Commission Expires 05-09-2026 <br />