Laserfiche WebLink
RE: MINING RECLAMATION PERMIT APPLICATION <br />COLO STAT. 34- 32- 112.10.8 <br />DATE RECEIVED •• 1 <br />7,Y <br />Signature <br />) Clerk and Recorder <br />Katie Barr _Fremont County Clerk & Recorder <br />Barr - Fremont County Clerk & Recorder <br />615 Macon Avenue, Room 102, Canon City, Colorado 81212 <br />Phone 719 - 276 -7330 Fax 719- 276 -7338 <br />NAME OF APPLICANT <br />DATE OF HEARING <br />NAME OF CONTACT PERSON <br />PHONE NUMBER e= 1:3i9 `GJ �T <br />Please check which applies to your permit: <br />I wish to be contacted 30 days after the hearing to pickup the application <br />I do not wish to pick up the application 30 days after the hearing and hereby give the Clerk's <br />Office permission t estroy <br />Date of Disposition Clerk <br />