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7. <br /> H <br /> NOTE TO COMM F.NTORS/011.1E000RS. Certification: <br /> As an authorised repreuntative of the applicant.I hereb% ceniN that the operation described has net the minimum <br /> It is likeh'there rill be addition,.drange,,and deletions to this documentprior to final decision he the Off-ice.Therefore,if lequtrnnents of the following terms and conditions: <br /> )uu have any Comments or concems you nuns contact the applicant or the Office prior to the decision date so than you w ill <br /> knot,what changes may have been made to the application document. I. I o the best of my knowledge.all significant,valuable and permanent man-made stneuuc(s)in existence al the time <br /> this application i,filed,and located within 200 feet of the proposed aliened area have been idenut tied in this application <br /> l�he Office is not allowed w consider comment,unless they are written,and received prior to the end of the public comment <br /> period. You should contact the applicant for ate final date of the public comment period. (Section 34-32.5-1 15(4)(e).C.R.S.1. <br /> 2. No mining operation will be located on lands where such operations are prohibited by law <br /> Ifyou have questions about the Mined Land Reclamation Board and Oflice's review and decision or appeals process,you ma, (Section 34-32.5-1 150)(1),C.Ws.: <br /> contact the Office at(303)866-350. <br /> 3. As the applicant/operator.I do not have any extraclion4•yrloraion operations in the State of Colorado currently in <br /> violation of the provisions of the Colorado Land Reclalnaliun Act for the Extraction of Construction Materials <br /> (Section 34-31_c-I NI.C.RS_)as determined through a Board finding. <br /> 4. 1 understand that statements in the application are being made under penalty of perjury and that false statements <br /> made herein arc punishable as a Class I misdemeanor pursuant to Section 18.8-503.C.K.S. <br /> ?Iris f unr ha,been approved bl'th-Vined Lnod Reclamation 11onrc1 pur-ant to seetiolr 34-32.5-112,CR.S...aJ the Colorado Land <br /> R.larrratioa A,/Io,the E.arurlian fCun,trnrtioa.Ahrteriale.:bq•nhrnnlnu nr nro<Iificrtlhln r/IhlsJnnn,hal/msulf in rnlding rim• <br /> perms(issued on the altered or mudilied Jong and suhie,i the ap,,-tar to cerise and desist order,and civil penalic,/or operofinA <br /> „'Ifllmlf a pernlir parnlant 1..,er'flnn 34-12,5-123. <br /> Signed and dated this '+. day of <br /> 1 !6G'/�R L��>r1�1 _ If Corporation Attest(Seal) <br /> ApplicanU peruoi or Corepam Name <br /> Signed: k9 Signed: 13t- 1� A <br /> Corpn!.nc Seurtax or Eytuv:drnl <br /> title:County Commissener To,rn/('ily/County Clerk <br /> State of L C il•-d<�C 1 <br /> )ss. <br /> County of ) <br /> The foregoing instrument was acknowledged before me this 3( / day of_ !r t _ __•___ <br /> .by '!Lot <br /> RANDALL D.SCNAVL <br /> NOTARY PUBLIC - 1""-`_L' %'-" •=�('"LC_.,' <br /> STATE OF COLORADG <br /> NOTARY ID 19954016062 <br /> MY COMMISSION EXPIRES 12106121'14- V-f}Curium„wry <br /> SIGNATURES MUST BE IN BLUE:INK <br /> 1•ou must Pon,uilicienl Notices at the location of the proposed mine site to clearly identify the site as the location of a <br />