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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 45 Acres 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 Cib tiV1 1 Cc.,n1 6r ww,A,-lol Representative Name <br /> Date I I z/-2 3 "Title 'W CAS 19—" (AA CA z-•� <br /> STATE Odo6(G6 O ) <br /> ss. <br /> COUNTY OF C p ,e)4 ) <br /> The foregoing was acknowledged before me this_12--_ day of Gn Jar 4 20 23 by <br /> r�nr��.-Nt1� �-- as vaa�e,r_�e5ov�r�ss9a,2 �f-� 1�-rn�n bSj C�c' <br /> My Commission Expires: f'e b r J ec rtt 9 ' 20LS <br /> Notary Public J <br /> CATHERINE HARRIS <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20214005321 <br /> MY COMMISSION EXPIRES FEBRUARY 9,2025 <br />