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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 Sleepy T Over Three (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 /> / � 6 <br /> Applicant � Representative Name <br /> � e <br /> Date 03, 20t� Title D R W�5 AG�w,-i v� <br /> STATE OF ) <br /> ss. <br /> COUNTY OF ` <br /> eIr"2fore oin was,a acknowledged before me this��Gday of , 20 , by <br /> cl(k as S o <br /> My Commission Expires: <br /> Notary Ploic <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 19964012722 <br /> ml mi iom Eft im AUjW§11 UZ <br />