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-2- <br />This fonw has been approved by the Maud Land Redemaden Board pursuant to sections 34-32--119, CR.&, of tke <br />Mined Land Reclamation Act and 34-32.5-119, CALS., of the Colorado Land Reclamation Act for the Extraction of <br />Construction Materials Any alteration or modification of this form shall result in r 4mg any permit issued on the <br />altered or moth, feed fonw and subject the operator to cease and desist ordars and ch4 penattim for o ug wA*out a <br />permit pursuant to sections 34-32-123, CR.&, of the Mined Land Reclamation Aet and 34-323-123, C.R.S., of the <br />Colorado Land Reclamation Act for the F..zbaction of Conshwedon Materials. <br />Applicant and Successor hereby request the State to consent to the assignment of the approved Permit Application to <br />recognize the Successor as the approved Applicant under the permitting process. <br />Sunnyside Gravel <br />Name of Permit Applicant <br />By <br />tune Officer <br />Sunnyside Gravel & Excavation <br />Name o Su licant <br />By <br />i Officer <br />Owner Owner <br />Title of Officer Title of Officer <br />NOTARY FOR PERMIT APPLICANT <br />STATE OF ko nO --, <br />COUNTY OF La- P ??A-c--, ss. <br />1 <br />The foregoing instrument was acknowledged before me this I D day of ?2 ???,14Qf' ??y <br />^ , . %A-- <br />?,`,? as b W Cif of <br />A Alo T,M NOTARY PUBLIC <br />r <br />My Commission expires: <br />(j?4??? NOTARY FOR SUCCESSOR APPLICANT <br />STATE OF r,.Br' Q rQ c-, <br />COUNTY OF L4-, 9 \Q 4^, ) ) <br />The foregoing instrument was acknowledged before me this 10 day of 1r ,o }z or by <br />ANEYy as _(X L Y\ of_5c.i inr« Culp (rrC_ ? (? E1r?c. j??, <br />4 INCT4.v J. r NOTARY PUBLIC l <br />'08LIC ep My Commission expires:_- L