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CERTIFICATION <br /> The Applicant, Washington County - Dist 2 (print applicant/company name), <br /> by Robert Frick (print representative's name), as DRMS Admin. (print <br /> representative's title), does hereby certify that Colorado Land Board (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 Chris Aageson Pit #2 Addition (operation name), <br /> File Number M- - <br /> This form 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 for Hard Rock, Metal, and Designated Mining Operations. <br /> Any alteration or modification to this form shall result in voiding this fornt <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: <br /> Applicant 4 1 C-oaPj - Representative Name <br /> Date 0e, aD1� Title <br /> STATE OF <br /> ss. <br /> COUNTY OF ) <br /> e fore oin was acknowledged before me his day of , 20 , b <br /> y L� as ,L l m r� of <br /> ej My Commission Expires: - p <br /> NotayP 'c <br /> �4 e.Mo'iga�r <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 19964012722 <br /> M Commission Ex Ueb Au ust 10,2020 <br />