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CERTIFICATION <br /> The Applicant, Bent County (print applicant/company name), <br /> by Calvin Feik (print representative's name), as Bent County Administrator (print <br /> representative's title), does hereby certify that Mike Spady (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 Bent Co State Pit (operation name), <br /> File Number M-2021-005 <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 C',.ti,c6 Representative Name 4: <br /> Date ?11 Y!2o2 t Title $esa t Co ri•r � �ilsfir�S �✓' <br /> STATE OF Glore,4C ) <br /> ) ss. <br /> COUNTY Of= <br /> Thetforegoing was acknowledged bei'ore me this Hfkday of V 1 ,20A 1 , by <br /> CAW i v\ Fe-1, as A gr of lee v rA i <br /> at - My Commission Expires: <br /> Notary Public <br /> TORE <br /> STA ETOF CO ORApp + <br /> NOTARY ID 1>P974pp3957 <br /> my ID <br /> oatnrto25 , <br />