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-8- <br /> Certifi ation: <br /> As an uthorized representative of the applicant, I hereby certify that the operation described has met the minimum <br /> requirements of the following terms and conditions: <br /> 1. To the best of my knowledge,all significant,valuable and permanent man-made structure(s)in existence at the time <br /> th is application is filed,and located within 200 feet of the proposed affected area have been identified in this application <br /> (Section 34-32.5-115(4)(e),C.R.S.). <br /> 2. No mining operation will be located on lands where such operations are prohibited by law <br /> (Section 34-32.5-115(4)(f),C.R.S.; <br /> 3. As the applicant/operator,I do not have any extraction/exploration operations in the State of Colorado currently in <br /> violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials <br /> (Section 34-32.5-120,C.R.S.)as determined through a Board finding. <br /> 4. I understand that statements in the application are being made under penalty of perjury and that false statements <br /> made herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503,C.R.S. <br /> This fo has been approved by the Mined Land Reclamation Board pursuant to section 34 32.5-112,CR.S,of the Colorado Land <br /> Reclamation Act for the Extraction of Construction Materials. Any alteration or modification of this form shall result in voiding any <br /> permit ued on the altered or modified form and subject the operator to cease and desist orders and civil penalties for operating <br /> without permit pursuant to section 34-32.5-123, C.R.S. <br /> Signed d dated this 2nd day of April 2014 <br /> Huerf4.no County Government If Corporation Attest(Seal) <br /> Applicnnt/Operator or Company Name <br /> SigneiiK--A=� .. e, �.� Signed: <br /> ' Corporate Secretary or Equivalent <br /> Title: Chairman Town/City/County Clerk <br /> State of', dth 1'/6/0 ) <br /> )ss. <br /> County tf. c/401,9./2 0 ) <br /> 4 <br /> The forgoing instrument acknowledged before me this 4 b day of C J <br /> ,10-/,b ev hlnr as (�ik�i.yflt ) o, f'(.t1_ -i Wr: - <br /> • <br /> �.. {SERVIGIL ; r _i, 1(9 ' <br /> •., MY PUBLIC <br /> STATE OF C' * - ' *` Notary Public <br /> NOTARY.ID 19954014699 <br /> MY •,• ; „ r.•,, EXPIRES SEPTEMBER 29.2015 <br /> My Commission expires: / 'i ,__ <br /> SIGNATURES MUST BE IN BLUE INK <br /> You must post sufficient Notices at the location of the proposed mine site to clearly identify the site as the location of a <br />