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CERTIFICATION <br />The Applicant, FIUERFANO COUNTY GOVERNMENT (print applicant/company name), by <br />,L &;A / (a i e p "It representative's name), as 141z1Cl L tC <br />(print re resentative s titl does hcrcb+ certify that IAN SC DOLORES CAMPBELL structurcl +rner <br />shall be compensated for any damaue from the proposed minim, 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 PEAK VIEW GRAVEN_ III f (operation name), <br />This fornt has keen approved by lire Colorado Alined Land Ruch ntation Board pursuant to its <br />autliority under the Colorthalo Laird Reclrtntattio►h Act fur the F..vtr(rctiun o %Construction Materials <br />and the Colorado Mined Laud Recknnation Act f itr Hard Rock, Xletal, and Designated Mining <br />Operations. <br />Ant• alteration or modification to this furnr shall resttl/ in voiding this furnr. <br />NOTARY FOR PERMIT APPLICANT <br />ACKNOWLEDGED BY: <br />Applicant IIUERFANO COUNTY GOVERNME'N'T <br />Representative Name Art S. Bobian <br />Signe�''•_� Date 7/30/14 "hitle <br />Representative Name— Max Vezzani <br />Signed:_ Date <br />7/30/14 <br />Representative Namc Ed ar Garcia <br />Signed: f v/ Date.7. /30_1 L4 <br />SPATE OF <br />COUNTY OF <br />) ss. <br />) <br />Chairman <br />Title Commissioner_ <br />Title__Commi Sci oner <br />The foregoing was acknowledsed before me this 30 day of July �p14 h�• <br />Art S. B ian DENT ii1 Huerfano County Commissioners <br />urvjFa Notan! Public ", y Commission Expires: 9/29/15 <br />MY coMMISSIoN EXPIRES SEP BER 29.2015 <br />NOTARY FOR STRUC7'URF. OWNER <br />ACKNOWLEDGED BY: <br />Structure Owners: IAN & DOLORES CAMPBEI.I. <br />Representatiive�Name(S) IAN & DOL.ORFS CAMPI3I:I.I.__— _—_�_�,_ <br />Signed: cCYLh t�G "f . =L ��" %', ./1 ��L`(1 <br />Date Title _ CrU c 1 �ll7L, <br />STATE Or <br />COUNTY OF <br />The I'orecoing, + - to vie <br />NotarT Public "'J eeNJC <br />) <br />) ss. <br />dged before me this dad of _ 20_, by <br />as / of <br />�G1,e I� - PP t` my con, mission Expires: <br />