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CERTIFICATION <br />The Applicant, Lincoln County _(print applicant/company name), <br />by Trey James (print representative's name), as Land Use Administrator (print <br />representative's title), does hereby certify that Robert J. and Rosann Safranek 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 Gaede Pit <br />File Number M-1978-051 <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 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 PER -MIT APPLICANT <br />ACKNOWLLGED BY. <br />Applicant <br />Date <br />STATE OF ) <br />) ss, <br />COUNTY OF ) <br />Representative Name <br />Title <br />The foregoing was acknowledged before me this <br />as <br />Notary Public <br />day of , 20_, by <br />of <br />My Commission Expires: <br />