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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 Jeff & Casey Sprague (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 form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: <br /> Applicant Cou — Representative Name <br /> Date �Rp r<• 3 , 20/ <br /> STATE OF ) <br /> ss. <br /> COUNTY OF <br /> foregoin as acknowledged before me this day of , 20 by <br /> �� r;( JL as �f�mS 1r�EiM.s t1 of <br /> t• 1 My Commission Expires: <br /> Qotarublic <br /> 409sa 2.Af"94^ <br /> NOTARY PUBLIC <br /> STATE OF COLOPAGO <br /> NOTARY ID 199640; <br /> My Commission Expires Au u , <br /> sue_,__.___ <br />