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CERTIFICATION <br /> The Applicant, Arkins Park Stone, Corporation (print applicant/company name), <br /> by_Arlis M.Sprague (print representative's name), as Owner _ <br /> (print representative's title), does hereby certify that Larimer County (structure owner) <br /> shall be compensated for any damage from the proposed mining operation to the above listed <br /> structure(s) located on or within 200 feet of the proposed affected area described within Exhibit A,of <br /> the Reclamation Permit Application for Arkins Park Quarries (operation name), <br /> File Number M-1985-212 <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 Designate Mining Operations. <br /> Any alteration or modification to this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEDGED BY: <br /> ll� - <br /> Applicant-a 61presentative Name <br /> Date Title ( <br /> STATE OF l ) <br /> ss. <br /> COUNTY OF <br /> The foregoing was acknowledged before me this I? day of ace c7S t , 20 16, <br /> by 04RI(5 E�✓e as �waC/ of <br /> DEWEY C CHANDLER <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20034040354 <br /> Y COMMISSION EXPIRES ES DUNE JUNE 22,2020 <br /> My Commission Expires: ot► 22- ��ao <br /> Notary Pu i <br />