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C) <br /> RPM,Inc. <br /> CERTIFICATION <br /> 1'he Applicant,Elbert County Government,Elbert County"County".does herby certify that Elhcrt County <br /> Government"Property Ownef'shall be compensated for any damage from the proposed mining operation to the <br /> above listed structures(s)located on or within 200 feet of the proposed afhected area described within Exhibit A.of <br /> the reclamation Permit Application for the Peratit No.M-2001-056$elveal Gravel Pit. <br /> 77&jonn has Leery approved by the Colorado!dined Land Reclamation Baard pursuant to its atttltoritf•under <br /> the Colorado Land Reclumation Act for the Extraction of Construrtion 3faterials and the Colorado.Mined Land <br /> Reclamation Act far Hard Rack tiletal.and Uesi;,nated Afining Operations. Ali),alteration or nrodifieettiou to <br /> this form shall result in voiding this form. <br /> NOTARY"FOR PERNITl'APPLIC&N1' <br /> ACKNOVvI.FD(;FD BY: e(5A <br /> Applicant Elbert CountyGovernment Representative Name e �� <br /> Date �'1 ��,2a�� . — line _�K �12�>v in,Q•= -:l_ o_F__.f?at� ftui� f�t`c��' <br /> I <br /> STATE OF <br /> COUNTYOF+. :_;;� �� as <br /> The foregoing was acknowledged beforq me thi' ` `,_ day oG ._ \. .20-1�,by ''�;'�'rt. <br /> of <br /> Niv Commission Expires: <br /> Igo Pab1lC J5A&1ArY!C'.VCZ t <br /> :o zry Rwt c Stan�f r.D� ' <br /> tlataytD:oC9 n9G607'ARYSTRUCTUREONVNER <br /> Gil Coma.!nn Exp;res Jun <br /> ACKNOWLfa)GFa)HY: <br /> 1, l <br /> Structure Owner:Elbert County Government ltepre;entanve`atne: <br /> Date 'I �(/.7 Title <br /> STATE OF ) <br /> COUNTY OF ) <br /> The foregoing was acknowledged before ate this__ day of,,-- .. 20—by as <br /> of <br /> Nly Commission Expires: <br /> Notary Public <br /> 11 <br />