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RPM,Inc. <br /> CERTIFICATION <br /> The Applicant,Elbert Count}'Govemment,Flberr County''County",does herby certify that Robert L.Beb cal <br /> "Property U.cner'shall be compensated for any damage fivm the proposed rnuriug operation to the above listed <br /> Structures(s)located on or x ithin 200 feet of the proposed affected area described within Lxhibit A.of the <br /> reclamation Permit Application fur the Pconit No.NI-2001-056 Belveal Gravel Pit. <br /> This form has been approved by the Colorado Mined Land Reclamation Board pursnrint to its authority under <br /> the Colorado Land Reclamation Act for the Extraction of Construction Materials and the Colorado alined Land <br /> Reclamation Act for Hard Rock,foetal,and Deai�gnated Afinirrp operations. Any alteratian or rrradifealioti to <br /> this form shall result in voiding this farnL <br /> NOTARY FOR PFRhiIT APPLICANT <br /> .ACKNOWLEDGED BY- <br /> Applicant: II=lhert County Government Representative Naute. - <br /> ��- <br /> Date r'' ;'j 2S J'� U( _ "I itle i t?t s rt't�e7 i'�D tit <br /> 1• _ <br /> COUI IM-OF,-_`''• ' _ i i, ..;'•% = ` <br /> The foregoing xi-is acknowled ed heforc the tfiis da}'of _ 10_.U}s �_-'i_`-- ---- .as <br /> Of <br /> My C ommi.ston Expires: <br /> �.t <br /> TLatai e ' <br /> `•t._.. FUG'.."-Staff:Jf''ctara:'c NOTARY S'I'KLtC."CURE UWNI:K <br /> Motsry ID:rr<.,tS053 <br /> r.4i._7.l;Ya•;.tan Fxp`'es,UnS 20211 <br /> Structure Owner:Robert Belvcal Repre.sentative Name: ;?�tqq(` /�Ff�E,,i/" <br /> Date �/ ��rl � Title �``ti r7L2i2 <br /> STATE OF ! •+ tt <br /> Co I,TN, TY OF 1 <br /> I he foregoing%vas acknowledged before me this t_ day of __- _'.20 ' , ,b} `' " ' as <br /> ! tify C'ommisston Expires: l <br /> Notan^Public <br /> 9 <br />