Laserfiche WebLink
•r ~ ~ IIIIIIIIIIIIIIII III • <br />'.: ~ ~ STATE OF COLORADO <br />,~ - <br />MINED LAND RECLAMATION DIVISION <br />Department of Natural Resources 4ECEIVFC ~~°F'48 <br />Nc <br />t3t35hermanSt.,Room2t5 <br />Denver, CO 80203 '~_t8 ~` <br />303 866.3567 qpR 2 ~~3 ~r~; ;' <br />Fa x: 303 832-8106 <br />Roy Romer. -- <br />~IVi$IDn UI IVIIOQIdiS ti GeUI;)~y Govemw <br />FreO R. Banta. <br />DIVIEIOn DIlEwOr <br />TRANSFER OF PERMIT AND SUCCESSION OF OPERATORS <br />APPLICATION FORM <br />The application for a TransfE!r of Permit and Succession of Operators must contain three <br />(3) mayor parts: 1) an Application Form; 2) a Performance Warranty (attached as part of <br />the Application Package) bearing the original notarized signature of the Successor <br />Operator; and, 3) a replacemE~nt Financial Warranty (for the amount maintained by the <br />current permittee) provided tly the Successor Operator, bearing an original notarized <br />signature. 7o expedite proee~ssing, please provide the information in the format and <br />order described below. ~O _ ~ f <br />I. ADMINISTRATIVE INFORMATION <br />1. Permit Number: <br />2. Operation Name: <br />M-ai-naa <br />Jens O. Solberq Pit <br />3. Current Permitted Operator: <br />Contact Person: <br />Robert A. Solberg, Personal Representa- <br />of the Estate of Vida S_ Snlharn <br />Company Name: visa S. solberg <br />Street: 13335 Stockman Court <br />City: Peyton <br />State: CO Zip Code: 80831 <br />Area Code: 719 Telephone: 683-3198 <br />4. Successor Ooerator: <br />Contact Person: Robert A. Solberq <br />Robert A. Solberg Dennis L. Solberg and <br />Company Name: x?+1,,00„ C FrPnr•~ Ton~ry~c yry ~ilEl~ <br />Street: 13335 Stoclanan Court <br />City: Peyton ___ <br />State: ~ Zip Code: 80831 <br />Area Cade: 719 Telephone: 6R~-ligR <br />IRS Tax ID No. or Social Security No.: <br />5. Application Fee: 5100.00 J i' I y 7. Ery <br />