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C) <br /> RPM,Inc. <br /> CERTIFICATION <br /> The Applicant,Elbert County Government,Elbert County"County",does herby certify that Robert L.Belveal <br /> `Propeny Owner"shall be compensated fbr 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 Belveal Gravel Pit. <br /> This form has been approved by the Colorado Alined Land Reclamation Roard pursuant to its authority under <br /> the Colorado Land Reclamation Act for the Extraction of Consiruclion-Materials and the Colorado Mined Land <br /> Reclamation Act fur Hurd Roc/4 Metal,and Designated Mining Operations. Any a/teradon or mod?fcation to <br /> this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEDGED BY: <br /> Applicant: ElbertCourityGovernment Representative Name: <br /> Date .. .. S_ _-------_-_—. 'I'itlesu xg;e R�sop-T"Or 260 lb-ID My-&- <br /> SI:ATE OF � ) <br /> COUNTY O \ <br /> The_forego foregoing was acknowl ed bef'are me,tJ�is�day of C t"� 20 L by `�} y� as <br /> of <br /> My Commission Expires: . :, <br /> LISA HACKIE WICZ <br /> No aryPublic-stateofColorado NOTARY STRUCTURE OWNER <br /> Notary 10 20094019061 <br /> Commission Expires Jun 9,2021 <br /> Structure Owner:Robert Belveal Representative Name: r <br /> Date //�2 L1/1 (Z Title <br /> STATE OF (..r I0FAU__) <br /> ) <br /> COUNTY OF <br /> I he foregoing was acknowledged before the this 11rr y Y <br /> -�T day of�A#,& .20 b <br /> Commission Expires: <br /> N* ublic <br /> JANA WELLS <br /> .�� NOT,%Fre PLIBLIC <br /> E Gt:t"flLQRAQC) <br /> NOTARY D 201'f 77iT <br /> Ln,coraamtott 8c�cFweEx n,2tn� <br /> 9 <br />