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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 ne-o r-, Coyr,-L _ —Representative Name <br /> Date �;' _ Title :x�—�trak.c�c <br /> n <br /> STATE OF ( & L 1 <br /> ) ss. <br /> COUNTY OF b 0 ) ) <br /> The foregoing was acknowledged before me this At day of T� , 1 , 20 �?t�; by <br /> der�,it l as Lori <br /> r- <br /> 1 ; <br /> My Commission Expires: <br /> Notary Public <br /> CHRISTINE HOLLENBAUGH <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20184017122 <br /> MY COMMISSION EXPIRES APRIL 19,2022 <br />