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5TtCc,tGZc.l�2Cs A&'M-F (OptQ-113 <br /> CERTIFICATION <br /> San Miguel County Colorado <br /> The Applicant, (print applicant/company name), " <br /> by Lynn Black (print representative's name),as Counf� Administrator (print <br /> representative's title),does hereby certify that iX Service.CQ. of_Col oraSbtructure 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 Pathfinder Pit (operation name), <br /> File Number M- 1994 113- <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 Designated Mining Operations. <br /> Any alteration or modification to this form shall result in voiding this form. <br /> NOTARY FOR PERNIIT APPLICANT <br /> ACKNOWLEGED BY: ( //!/L�/�.--�--- <br /> Applicant San Miguel County, CO. Representative Name Lynn Black <br /> Date 10/5/2016 Title County Administrator <br /> STATE OF rnlorado ) <br /> )ss. <br /> COUNTY OFSan Miguel ) <br /> T�y foregoing was acknowledged before me this 5 day of b6fdoer ,2016,by <br /> (.- rf,new t10-r-f;;e1das 4! ep ,QC' u/i of ec h rYIi ei* COGcn �a <br /> t�.. Cpm.rYe+srs t c,n e.r5 <br /> My Commission Expires: °y�� c;26Q <br /> otary Public <br /> CARMEN LYNN WARFIELD <br /> Notary P#) <br /> State of Colorado <br /> My CommtWo EE Notary ID 20164015831 <br /> i s 6,2020 <br /> 3 <br />