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CERTIFICATION <br /> The Applicant, SEMA Construction Inc. (print applicant company name). <br /> by Mark Brooks (print representative's name),as District Vice President (print <br /> representative's title).does hereby certify that Marilyn Schneider (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 Betz Borrow Pit (operation none), <br /> File Number M- <br /> This form has been approred ky the Colorado Mined Land Reclamation Board pursuant to its <br /> authorir,under rite Colorado Land Reclamation Act for the Extraction of Construction Materials and <br /> the Colorado Wined Land Reclamation Act for Hard Rock,Metal,and Designated.alining Operations. <br /> Anr alteration or modification to this form shall result in raiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: <br /> Applicant G /nl4 dfJST21.L?tom Representative Name <br /> �a <br /> Date ��� ¢ ,�(� / �' Title District Vice President <br /> STATE OF O or^ad o } <br /> }SS. <br /> COUNTY OF ahoe ) <br /> The foregoing was acknowledged before}tee tits+1 day of eMb-e✓.20�?t by <br /> Hate to, �a:gDiCs as7)4jYtcfylcC ltSjdt,rtf �uG�taa <br /> My Commission Expires: <br /> 'otaty bait <br /> NANCY T GUERRERO <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20124067633 <br /> MY COMMISSION EXPIRES 10M912020 <br />