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CERTIFICATION <br /> The Applicant, City and County of Broomfield (print applicant/company name), <br /> by Brennan Middleton (print representative's name), as Water Resources Manager (print <br /> representative's title), does hereby certify that Platte Land and Water LLC (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 Heit Pit Resource (operation name), <br /> File Number M-2003-016 <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 G, } �,pp pvttl �wY, (�,�a�,,,�_ c,1 Representative Name <br /> Date 1/12-1Z3 Title wait:✓ P—✓fi.)uVtaf t"aoa76e- <br /> STATE OF _) <br /> ) ss. <br /> COUNTY OFF ) <br /> -p The foregoing wasacknowledged before me this/22 day of X)a—e , 20 23, by <br /> i�e y)narx as <br /> �l�C 1Pby� --- lrvr of oEc nom <br /> My Commission Expires:_ Q 6 -a c 2 D z <br /> ---- ------ - <br /> Notary Public <br /> 7NOTARY <br /> HARRIS <br /> UBLIC <br /> LORADO <br /> 214005321 <br /> MY COS FEBRUARY 9,2025 <br />