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CERTIFICATION <br /> The Applicant, Lincoln County (print applicant/company name), <br /> by Ty Stogsdill (print representative's name), as Land Use Administrator (print <br /> representative's title),does hereby certify that (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 Eichman Pit (operation name), <br /> File Number M- 1985_ 105 <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 re co In Lu,n�(Representative Name <br /> Date Title Lnnzyl rd 22, <br /> STATE OF S,gAo ro, ) <br /> ss. <br /> COUNTY OF <br /> The fore oing was acknowledged before me this {�day of ,20_a, by <br /> as f ncol n Cn«r,hl <br /> My Commission Expires: 9S 2.5 <br /> No ary P i <br /> BAILEY MARES <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20174048743 <br /> MY COMMSSION EXPIRES NOVEMBER 28,2125 <br />