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. . <br />CERTIFICATION <br />The Applicant, Lincoln County (print applicant/company name), <br />by John DeWitt (print representative's name), as Land Use Administrator (print <br />representative's title), does hereby certify that Charles Hoffman (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 Hoffman Pit <br />File Number M-2005-144. <br />(operation name), <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 forma <br />NOTARY FOR PERAUT APPLICANT <br />ACKNOWLEGED BY: <br />Applicant Lincoln County Representative Name <br />Date /> ^ / Title C KJ <br />STATE OF ' , ) <br />) ss. <br />COUNTY OF Lv-c c k <br />The fore noing was acknowledged before me this3C3k of , 201 , by <br />as tic\ Se A �\ . <br />My Commission Expires: ,,,,v /'� , j p ) <br />tARAY BECKER -PATTON <br />Notary Public <br />state of Colorado <br />