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I <br /> CERTIFICATION <br /> Weld Count Public Works <br /> y o ks <br /> The Applicant, (print applicant/company name), <br /> by Mike Freeman (print representative's name),as Chairman of the Board of County Commissioners(print <br /> representative's title),does hereby certify that Nunn Telephone Company (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 Koskie Pit Amendment o eration name <br /> Pp ( p ). <br /> File Number M-2014-024 • <br /> This form has been approved b the Colorado Mine L r d and Reclamation Beard pursuant suant to its <br /> j PP Y P <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 /> An alteration or modification to this arm shall result in voiding <br /> yj ording this form. <br /> TARY FOR STRUCTURE OWNE <br /> ACKNOWLEGED BY- <br /> Structure Owner Representative Name c,,a,�,�//�_ <br /> Date -=�� /� 2a Title <br /> STATE OF } <br /> •'' '' )ss. <br /> COUNTY OF_� 1� ) <br /> T e foregoing was acknowledged before me this day of . 20 1h by <br /> ,,d�/ as o A� <br /> My Commission Expires: <br /> Notary Public <br /> M STUMPF <br /> aIY publice of ColoradoID N)U0940389A3CF:Not <br /> ronEx iresl2.01.2021 <br />