Laserfiche WebLink
CERTIFICATION <br /> The Applicant, Siete Inc. ,(print applicant/company name), <br /> by Baxter Kirkland (print representative's name), as1 eS{dent (print <br /> representative's title),does hereby certify thatSan Isabel Electric Association inc.(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,ofthe Reclamation <br /> Permit Application for Lascar Pit (operation name), <br /> File Number M-2023-005 . <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 mod1cation to this form shall result in voiding this form. <br /> • NOTARY.FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: <br /> Applicanj�` ��•�=�/c Representative Name b t,/ Id• CAY <br /> Date 4-1/)11 j23 Title IX'VCIC (0�1 <br /> STATE OF ttikr o ) <br /> ((�� }ss. <br /> COUNTY OF 't'L(�„(�!p ) <br /> The foregoing was acknowledged before me this e'tl?day of Aprii ,200i by <br /> tkktr W•1.jrjLgtt/t as -Pr drib 1°i& of O5i tke lye ► • <br /> My Commission Expires: jut tell oa-tc <br /> t blie <br /> JODI D SCHREIBER <br /> NOTARY PUBLIC <br /> STA rE OF COLORADO <br /> NOTARY ID 20064001792 <br /> MY COMMISSION tcXPIRFS OCTOBER 6,7026 <br />