2004-09-24_REVISION - M2003016 - Laserfiche WebLink

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-2- Thisform has been approved by the Mined Land Reclamation Board pursuant to sections 34-32-119, C.RS., of the Mined LandReclamativnActand34-32.S-I19, C.R_S., oftheColoradoLandReclamationActfortkeErtraction of Construction Materials. Any alteration ormvdifrcatianojthisjormshallresultinvoidinganypermitissuedon the altered or modified form and subject the operator to cease and desist orders and civil penalties for operating without a permit pursuant to sections 34-32-123, C.RS., of the Mined Land Reclamation Act and 34-32.5-123, C.R.S., of the Colorado Land Reclamation Act for the Extraction of Construction Materials. Applicant and Successor hereby request the State to consent to the assignment of the approved Permit Application to recognize the Successor as the approved Applicant under the permitting process. sw trEnnow, LLC Name of Permit Appfli .ant By l~~l G~~ Signature of Office Manager Title of Officer SW CHt1MBERS, LLC Name of Successor Applic By Signature of Offic ,• ~~~ Title of O er NOTARY FOR PERMIT APPLICANT CTATF pg COLORADO COUNTY OF~AP~OE ) SS. The foregoing instrument was acknowledged before me this 14th day op September 2004- ''~~ by Mazk D _ Campbell ys Manager oaf ' : % ' SW Meadow, LLC ~ '~ ~ '~;~: " I ? ~, -• '~ ~ - ~ ` ~ Y~ r ~ '' c~ ~ - OTARY PUBLIC ` ^~ .-, = ,; ~ -,.,.. - ~ I MyCommission expires: ~ 81D 3 NOTARY FOR SUCCESSOR APPLICANT STATE OF COLORADO ~ ss. COUNTY OF ARAPAHOS 1 The foregoing instrument was aclmowledged before me this 14th day of September 2004 Mazk D. Campbell b Manager f y ~ o SW Chambers, LLC / / ~ `__ O ARYPUBLIC ^- My Commission expires ;^ .. ..~ - i ~ n:~