Laserfiche WebLink
otoNT C0, otiT Co 0M0NT C00 <br /> w45. <br /> �� co <br /> VOTE ALMLY.f4 <br /> MAKE FREEDOM GOUM <br /> t J' I-)'_{'�ll '" n''Pr <br /> �L� <br /> Office of the eteith and <br /> MINING RECLAMATION PERMIT APPLICATION <br /> CRS 34-32-112 (10)(a) (filing Only) <br /> J `Applicant Name tiCl 0CiOCX (' Date Received � a <br /> a , <br /> Permit # --1� 1 Q - 0S ; - <br /> Date of the Hearing - - <br /> ) <br /> 2ontact Name-and Phone #: -- -_ <br /> Name: mot_ t `r: = e c7'�.a Phone # 71' 7� -- <br /> please print = '`-`=Rr-,,- <br /> Please check which�:bo -:.applies to your permit: _' = _ }-* <br /> ❑ I wish to be cont:acted-30_days after the hearing to pickup e ;pplication <br /> 2(I do not wish to pickup!the appIicat on 30_d_ays:after--the=iea=r-ing and I hereby give <br /> the Clerk's Office permission to destroy filing <br /> Signature . -5- _..-74 <br /> Accepting Clerk: g(1 Date of Filin ( ? U/ / 1- <br /> P g <br /> ( ju4tin 0 cAant nt <br /> s i enwnL Cain etexii and Neavide't <br /> '5 .Macon Clue Suite 102/103 <br /> Caiioa Ca*,Cl9 81212 (7/9)-276-7332 tia.gwantPuun@henwntco..cam. <br />