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REV100975
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REV100975
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Entry Properties
Last modified
8/25/2016 1:11:28 AM
Creation date
11/22/2007 12:41:30 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
M1981286
IBM Index Class Name
Revision
Doc Date
10/8/1991
Doc Name
REGULAR OPERATION 112 RECLAMATION PERMIT APPLICATION FORM
Type & Sequence
CN1
Media Type
D
Archive
No
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<br /> <br />-5- <br /> <br />4. I understand that statements in the appitcation are being made under penalty <br />of perjury and that false statements made herein are punlshabie as a Class 1 <br />misdemeanor pursuant to Section 18-8-503, C.R.S. <br />Signed and dated this ~ day of /q9~--. <br />Weld County Board of Commissioners <br />Applicant/Operator <br />By: <br />Title <br />State of Colorado ) <br />ss. <br />COUnty Of Weld <br />s <br />~~~~~~~~ <br />If Corporation Attest (Seal) <br />We>Ad~~ County Clerk to Board <br />The foregoing instrument was acknowledged before me this~Q~y of ~g ~~ <br />by George Kennedy as Chairman pf Board of ounty Commissioner <br />Notary Publi <br />My Commission c+~iresJamiary 10,1995 <br />_' My Commission Expires: <br />(04/92) 2823E <br />
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