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CERTIFICATION <br /> The Applicant, City and County of Broomfield applicant/company name), <br /> by Brennan Middleton (print representative's name), as Water Resources Manager (print <br /> representative's title), does hereby certify that Meadow Island Ditch Company (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 (�,.�,,� _aigj- >uvt _o r2,n, l�Representative Name_Out,�..oy-c _ <br /> Date ---11L211 /Z --- - Title tom,Ow_1����-�� t�s GytuKu Q—�- <br /> STATE OF <br /> c�_ ) ss. <br /> COUNTY OF�jc/x1^e 1�k_ ) <br /> The foregoing was acknowledged before me this 12- day of 3Ui\0C,1 OZ� by— <br /> rein , <br /> roja M,��je�vn- asW QC. ova t MGina rof o �e 1 <br /> My Commission Expires:/' braa f 91 �b 25 <br /> Notary Public <br /> CATHERINE HARRIS <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY I 20214005321 <br /> MY COMMISSION EXPIRES FEBRUARY9.2025 <br />