2012-09-07_PERMIT FILE - M2012018 ‎(2)‎

• Permit No: M2012018
• IBM Index Class Name: PERMIT FILE
• Doc Date: 9/7/2012
• Doc Name: 112 APPLICATION
• From: STONE CANYON QUARRY
• To: DRMS
• Email Name: TAK
• Media Type: D
• Archive: No

-S
The Applicant,
CERTIFICATION
Stone Canyon Quarry, LLC
(print applicant/company name),
byBrenda Buster (print representative's name), as Manager (print
representative's title), does hereby certify that Century Link (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 Stone Canyon Quarry, LLC
File Number M-2012 -018
(operation name),
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 C4);9 r LZ,(-Representative Nam C
Date Title
STATE OF 06)&0-d0 )
) ss.
COUNTY OF )
The foregoing was acknowledged before me this5 -= day of s %.mC}z✓ 20L12, by
Bc (gf -✓ as YYl Cr t_ Q—✓ of 's) C o C
My Commission Expires: 2-"2-2-014
*6#11C
TAYIER N WRIGHT
Notary Public
State of Colorado