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CERTIFICATION <br /> The Applicant, Cheyenne County {print applicant/company name), <br /> by Marcy Brossman (print representative's name), as County Administrator (print <br /> representative's title), does hereby certify that Mark L and Jacqueline L Ackerman (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 Ackerman Pit (operation name), <br /> File Number M-2019- 037 . <br /> This for-in has been approved by the Colorado Mined Land Reclamation Board pursuant to its <br /> authority under the Colorado Land Reclamation Act for,the Extraction of Construction Materials and <br /> the Colorado Mined Land Reclamation Act fof•Hard Rock,Metal, and Designated Mining Operations. <br /> Any alteration or modification to this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: l <br /> Applicant Cheyenne County Representative Name arcy,rossinan <br /> Date July 17,2019 Title County Administrator <br /> STATE OF Colorado ) <br /> )ss. <br /> COUNTY OF- Cheyenne ) ff <br /> The foregoing was acknowledged before a this day of bl` ,20, , by <br /> S6maA as t'0,41 l of a t40 <br /> My Commission Expires: F,2�V}, �, <br /> otary Public <br /> PATRICIA A DAUGHERTY <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 201540007448 <br /> MY COMMISSION EXPIRES FEB 20,2023 <br />