Laserfiche WebLink
CERTIFICATION <br />The Applicant, City of Greeley (print applicant/company name), <br />b Jon Monson (print representative's name), as Director of Water and Sewer (print <br />representative's title), does hereby certify that DCP Midstrea (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 25th Avenue Site (operation name), <br />File Number M -2002- 020 <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 />STATE OF <br />COUNTY OF <br />) ss. <br />NOTARY FOR PERMIT APPLICANT <br />ACKNOWLEGED BY: <br />Applicant Representative Name <br />Date Title <br />The foregoing was acknowledged before me this day of <br />as of <br />My Commission Expires: <br />Notary Public <br />, 20_, by <br />