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Certification <br /> As an authon zed representati\c of the applicant.I hereby certify that the operation docrtbed has met the minimum requirements of the <br /> following terms and conditions <br /> 1 1 his training operation will not ad%ersely affect the stability of ary significant,kaluable and permanent man-made structure(,) <br /> located\k ithin too hundred(200)feet of the affected lands (However,\k here there is an agreement between the applicanvoperator <br /> and the persons haking an tnterest in the structure that damage to the structure is to be compensated for by the applicant•'uperator <br /> (Section 834-32-115(4)td),C R S 1984. as amended), then ;pining may occur\s ithir 200 feet Proof of an agreement must he <br /> submitted to the Office prior to the dechion date ) <br /> 2 No mining operation \kill be located on land.\\here such operations are prohibited by lass (Section 34-32-115(4){f). C'.R.S <br /> 1984,as amended), <br /> 3. As the applicant operator,I do not hale an\ mining prospecting operations in this state of Colorado currently in k iolation ofthe <br /> prokisions of the Nfined Land Reclamation Act (Section 34-32-120, C R.S 1984. as amended)as determined throng*h a Board <br /> find;rag. <br /> 4 1 understand that statements in the application are being made under penalty of penury and that false statements made herein are <br /> punishable as a Class I misdemeanor pursuant to Section 1 R-R-501,C R S 104,as amended <br /> This jorm has been approved btu the Mined Land Reclamation Board pursuant to section 34-32-112,C.R.S., of the Mined Land <br /> Reclamation Act. -In'v alteration or modification of this form shall result in voiding a,iy permit issued on the altered or modified form <br /> and.subject the operator to cease and desist orders and civil penalties for operating without a permit pursuant to section 34-3 2-123, <br /> C.R.S. <br /> Signed and dated his day of�✓`'t 2Gf <br /> Cripple Creek Victor Gold fining Company If Corporation Arrest(Corporate county Seal) <br /> Appli- nt perator Na se <br /> Signature �— B <br /> Y <br /> Corporate Secretan or Eqursalew <br /> iitle Ge eral M nager ro,,ncity County Clerk <br /> Statc of <br /> { )ss <br /> County of �1 C� �� ) <br /> I : <br /> Hie foregoing instrument sk as ackno\k hedged before me this Z ` day of _, V h. <br /> ��jj►RIERD �(��(� V��t�\�vl� CU �-- <br /> rit1 t1OTAR <br /> a; Y N Notar ubhc <br /> i <br /> p811G11 <br /> N1k Commission expires: 1Li U-1) U <br /> ;.. <br />