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CERTIFICATION <br /> The Applicant,HUERFANO COUNTY GOVERNMENT(print applicant/company name),by <br /> Art S. Bob ian (print representative's name),as Chairman <br /> (print representative's title), does hereby certify that the HOLITA DITCH COMPANY (structure owner) <br /> shall 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 <br /> Reclamation Permit Application for LONE TREE GRAVEL PIT(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 Extraction of Construction Materials <br /> and the Colorado Mined Land Reclamation Act for Hard Rock,Metal, and Designated Mining <br /> Operations. Any alteration or modification to this form shall result in voiding this farm. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEDGED BY: <br /> Applicant HUERFANO COUNTY GOVERNMENT <br /> Represen . ' e Art S. Bobian <br /> Signed: 4111172Pr 4" �•- Date 12/17/14 Title Chairman <br /> Representative Name Max Ve zani <br /> Signed: Datc12/17/14 Title Commissioner <br /> Representative Name Ray Garcia <br /> Signed: Ze./64 'd2 ,G2A-?_2- . Date 12/17/14 Title Commissioner <br /> STATE OF (,�dL67-dit) ) <br /> )ss. <br /> COUNTY OF ) <br /> The foregoing was acknowledged before me this / 1 i day of <br /> clatt.6.,_ <br /> /20, ,by <br /> 4' S. ,.�. as ( ' 1hl1Afl of. !.s,. is oli,L• a. 6Mr►1t5.5; 1&M <br /> j <br /> Notary Public 1 h/l(La-- u My Commission Expires: -/�1l`..� <br /> • NI-ERVIGIL <br /> NOTARY PUBLIC <br /> STATE OF COLORADO, .,, <br /> NOTARY ID SEPTEMBBER 29.2015 <br /> MY COMMIS91taN EXPIRES <br />