Laserfiche WebLink
CERTIFICATION <br />The A pp licant, (,L L -t 1 t j (print applicant /company name), <br />by �(��' �C\ v1utc(print representative's name), as Chairman (print <br />representative's title), does hereby certify that l::.t,g, � k(ow) L (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 Beeson Pit <br />File Number M -2006- 048 <br />(operation name), <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 Eidraction 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 />Applicant 4 \ - t > l TOVk- l - Representative Name ha\,`,Cl <br />Date �� 2 —/ 3 Title 66 L C HA / P— <br />STATE OF C O((c(I p ) <br />) ss. <br />COUNTY OF 60,) <br />,) <br />The foregoing was acknowledged before me this ' "'`I day of jJ l �c , 20_L_3, by <br />I�Ct t'�C!' �- f�t'►� /1u1'1c; as �`l >C4i ✓l��Cc��l'C �c�'l' of <br />.ZT <br />/� `� My Commission Expires: .CCr� <br />otary Public <br />