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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'-) Representative Name <br /> Date Title <br /> STATE OF W 6440 ) <br /> COUNTY OF k I ss. <br /> The foregoing was acknowledged before me this day of JV(1('i ,20_L2-,by <br /> �I� ��cJln�n�tl as p,�p1: , �c of <br /> My Commission Expires: ds 'd�' ZOZ� <br /> Notary Public <br /> ,�. <br /> FORTUNATO GALAVIZ <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20184019275 <br /> MY COMMISSION EXPIRES MAY 4, 2026 <br />