2011-12-15_PERMIT FILE - M2011049

• Permit No: M2011049
• IBM Index Class Name: PERMIT FILE
• Doc Date: 12/15/2011
• Doc Name: Response to Preliminary Adequacy Review
• From: Blue Earth
• To: DRMS
• Email Name: ECS
• Media Type: D
• Archive: No

The Applicant, City of Greeley
b Jon Monson
CERTIFICATION
(print representative's name), as
representative's title), does hereby certify that Century Link
(print applicant /company name),
Director of Water and Sewer (print
(structure owner) shall
be compensated for any damage from the proposed mining operation to the above listed structure(s)
located on or within 200 feet of the proposed affected area described within Exhibit A, of the Reclamation
Permit Application for Treiber Lakes (operation name),
File Number M_2011_ 049 .
This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its
authority under the Colorado Land Reclamation Act for the Extraction of Construction Materials and
the Colorado Mined Land Reclamation Act for Hard Rock, Metal, and Designated Mining Operations.
Any alteration or modification to this form shall result in voiding this form.
NOTARY FOR PERMIT APPLICANT
ACKNOWLEGED BY:
Applicant Representative Name
Date Title
STATE OF )
) ss.
COUNTY OF )
The foregoing was acknowledged before me this day of
as of
My Commission Expires:
Notary Public
,20 ,by