Laserfiche WebLink
CERTIFICATION <br />The Applicant, Cooley & Sons Excavating, Inc. <br />b James Cooley (print representative's name), as President <br />representative's title), does hereby certify that SLV REC <br />(print applicant /company name), <br />(print <br />(structure owner) shall <br />be compensated for any damage from the proposed mining operation to the above listed structure(s) <br />located on or within 200 feet of the proposed affected area described within Exhibit A, of the Reclamation <br />Permit Application for Screening /Crushing Agg. @ Pepper Recharge Pi (operation name), <br />File Number M- 2011 034 <br />This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its <br />authority under the Colorado Land Reclamation Act for the Extraction of Construction Materials and <br />the Colorado Mined Land Reclamation Act for Hard Rock, Metal, and Designated Mining Operations. <br />Any alteration or modification to this form shall result in voiding this form. <br />ACKNOWLEGED BY: <br />Cooley ooley & Sons Excavatigg,Inc. <br />Date / - I - <br />STATE OF 64 <br />) ss. <br />COUNTY OF z L� /a'v�Zl�lc'J <br />The foregoing was acknowledged <br />di - iyLed 07 - key as <br />i.P1ll.0Inv <br />Notary l blic <br />NOTARY FOR PERMIT APPLICANT <br />Representative Name <br />Title <br />Preside <br />fore me this 9 day of 4.1-ltacty , 20 / , by <br />- e_4:cei ; t of ' e- -6- y. t joxo lCi� c t C <br />My Commission Expires: <br />