Laserfiche WebLink
CERTIFICATION <br />The Applicant, Cooley & Sons Excavating, Inc. <br />(print applicant /company name), <br />b James Cooley (print representative's name), as President (print <br />representative's title), does hereby certify that Rio Grande Canal (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 Pit (operation name), <br />File Number M- <br />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 />NOTARY FOR PERMIT APPLICANT <br />ACKNOWLEGED BY: <br />Cooley & Sons Excavating, Inc. <br />Applicant Representative Name <br />Date � - /;z <br />STATE OF �-e . <br />COUNTY OF Q-6/0(64-0 <br />The foregoin w s acknowledged before me this day of <br />r rn cQi as �( .i1.4,trlp 4,d, of <br />.P 0-A/A4D <br />Notary P lic <br />) ss. <br />Title <br />, 20 I <br />Q <br />y 5� eit v EiCa.cial; ) ,1 01C: <br />. <br />My Commission Expires: 3 / <br />