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CERTIFICATION <br /> The Applicant, Lincoln County (print applicant/company name), <br /> by Fred Lundy (print representative's name), as Land Use Administrator (print <br /> representative's title), does hereby certify that Douglas Stone (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 Elmer Stone Gravel Pit (operation name), <br /> File Number M-1978-080 <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 L,nc-o n l._oµg Representative Name red Ls►nJ %1 <br /> Date '� _ I �,' Title_Lan A Ain: <br /> n <br /> STATE OF <br /> /AI� ss. <br /> COUNTY OF C '{ ) ) <br /> The foregoing was acknowledged before me this,A day of <br /> d ��r 1;�( as LCi��/�4v rhn:� of , <br /> 14 di My Commission Expires: /�j -•�?( _�.� <br /> Notary Public " <br /> CHRISTINE HOLLENSAUGH <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY 10 20184017122 <br /> MY COMMISSION EXPIRES APRIL 19,2022 <br />