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RPM,Inc. <br /> CERTIFICATION <br /> The Applicant,Elbert County Government,Elbert County"County",dnes herby certify that Rubert L.Belveal <br /> "Property Owner'shall be compensated for any damage from the proposed mining operation to the above listed <br /> structures(s)located on or within 200 feet of the proposed affected area described within Exhibit A,of the <br /> reclamation Permit Application for the Permit No.M-2001-056 Beh'eal Gravel Pit. <br /> Thisform has been approved by the Colorado Alined Land Reclamation Roard pursuaul to ifs authority under <br /> the Colorado Land Reclamation Act fur the Extraction of Construction Materials and the Colorado Alined Land <br /> Reclamation Act for Hard Rock,?bieful,and Designated.lfbdng Operations. Any alteration or modlrcation to <br /> this form shall result in voiding This form. <br /> NOTARY FOR PERAITT APPLICANT <br /> ACKNOWLEDGED BY: <br /> Applicant: Elbert Countv_Govemment Representative Name: --- <br /> Date _ _ .8 (y/_ Tille OF 26hD tL-+D FJt�iV-� <br /> ST AIL'UP''_ <br /> COUNTY o ) - t - =.i�-mil;j�:✓ <br /> The forebrnng was ackricnvledged before me tits t+ day of_ - j .20 as <br /> i of <br /> My Commission Expires: . <br /> ---ti----fie <br /> LISA MAC'✓WAUCZ <br /> ac:c*yvucic-State ofCalaradc NOTARY'STRUCTURE OWNER <br /> Notary lB?Qt)9�1fX61 <br /> td ,=Jrr aryID Fxpb=S;uri9.2t12T <br /> ,J <br /> Structure Owner.Robert Beellveal Representative Name: <br /> Date l/:2 Z-// " X Title <br /> STATE OF <br /> i <br /> COUNTY OF '`•' I <br /> The foregoing was acknoivledged before me this 4 day of J i% 20 t__,by t �':r` �_ as <br /> of <br /> 1 t r <br /> 2`U..• tV`ry Commission Expires: <br /> Nom'a,'Public <br /> ' t <br /> AN A WE i.w <br /> V. � f'� 1p PY3Ei6if". <br /> sT;'emu'd91 v iti 'w i£CEtiHER tt,200 <br /> 9 <br />