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or-is Hatfizld <br />Counn~ Cter!c &. Rtcordzr <br />DATE RECEIVED o2 - 7' O ~ <br />RE: MINING RECLATMATION PERMIT APPLICATION <br />COLD STAT. 34-32-112.10.8 <br />NAME OF APPLICANT ft ~ >~rG rr~~ ~..~.. <br />permit #~~ ~"H c ~~14~0..~. •~ <br />C~er~ ancC~ZecorcCer <br />FREivSONT COUtiTY <br />6l~ Macon Atiznuz, Foom 102•Canon Cin~, Colorado 8 t312 <br />Phonz(7t9)Zi6-i336 Fas(il9)27~-1~9d <br />DATE OF <br />NAME OF CONTACT PERSON `' <br />Phones a17 S- `~/SLrf <br />pleas print ` <br />Please check which box applies to your permit: <br />'1`~ <br />I wish to be contacted 30 days after the hearing to pickup the application <br />I do not wish to pickup the application 30 days after the hearing and herby <br />give the clerk's nffirP narmieeinn to riictmv <br />07 <br />• date of dispostion clerk <br />