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-8- <br /> Certification: <br /> As an authorized representative of the applicant, i hereby certify that the operation described has met the minimum <br /> requirements of the following terms and conditions: <br /> I. To thc best of my knowledge,all significant,valuable and permanent man-madc structurc(s)in cxistcncc at thc time <br /> this application is filed,and located within 200 feet of the proposed affected area have been identified in this application <br /> (Section 34-32.5-1 15(4)(e),C.R.S.). <br /> 2. No mining operation will be located on lands where such operations arc prohibited by law <br /> (Section 34-32.5-I 15(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 thc 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 I misdemeanor pursuant to Section 18-8-503, C.R.S. <br /> Willi <br /> This form has been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-112,C.R.. ) o gild//nd <br /> Reclamation Act for the Extraction of Construction Materials. Any alteration or modification of this formal rg dlky <br /> permit issued on the altered or modified form and subject the operator to cease and desist orders anerlci ,r?t or trjeratingy <br /> without a permit pursuant to section 34-32.5-123.C.R.S. • : l \, i <br /> ts - <br /> • .. <br /> Signed and datcd this LOU(1 day of Ri\\ , , •471: ` .. <br /> •. 1, •�1: <br /> Connell Res► rces, nc. ••'••........••'•� <br /> If Corporation Attest, gfik G �• <br /> Applicant/Op rator or .mpany Name ////0 ' `',,�% <br /> --It_.........- �_ <br /> Signed: ..fined: ' .►!, _-� - <br /> ' Corpora a Secretary or Equivalent <br /> Title: President Town/City/County Clerk <br /> State of Cel °VU ) <br /> s . <br /> County of Lay.k_m_o- ) )s <br /> & p WThe foreg ing instrument was acknowledged before mhis day of <br /> ,QA-, 1p \1(1 KA. X( as `ce�1 L-t- of •I 1,1 ....., <br /> f llr_, <br /> Affnc. <br /> \ 1 _/k li 0 0 <br /> JENNIFER LINDBLAD „ A_A ' <br /> Notary Public Notary Publi I <br /> State of Colorado <br /> Notary ID#20144008302 I� �_� <br /> My Commission Expires 02-21-2026 My Commission expires: O . <br /> SIGNATURES MUST BE IN BLUE INK <br />