Laserfiche WebLink
CERTIFICATION <br /> The Applicant, MA-.474TE5 /J),ITFRiALS J/G (print applicant/company name), <br /> by Cot,E. 4M tEl2SEA1 (print representative's name), as S-F,Ahog V cL / tESi,JE.AfT' (print <br /> representative's title), does hereby certify that Kir CAR<oil CouArTy (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 f4-LoQmjc.Y Pa 1 (operation name), <br /> File Number M-1O O-017 . <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 /> ACKNOWLEGE Y: <br /> Applicant Representative Name (SLE A/UAERSEAI <br /> Date NMI /6./ .20)-11 Title SidtP,,e Oce 44S/AMT <br /> STATE OF 144A.0545 ) <br /> ss. <br /> COUNTY OF S11Qu) <br /> The foregoing was acknowledged before me this I Q day of W\ , 2029;by <br /> note_ Iair1P1.�Q,,1/$ y as 5tnkOr VA) of Q.14.5 c ' e5 . <br /> C �A�Q�V`,, My Commission Expires: '1 i I / <br /> tary Pu lic <br /> OPRY P&B, JESSICA L.KITCHEN <br /> Z NOTARY PUBLIC <br /> STATE OF KANSA <br /> STATE OF KANSAS My Appt.Exp. <br />