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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 /> 1. To the best of my knowledge,all significant,valuable and permanent man-made structure(s)in existence at the time <br /> this application is filed,and located within 200 feet of the proposed affected area have been identified in this application <br /> (Section 34-32.5-115(4Xe),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(4Xf),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 form has been approved by the Mined Land Reclamation Board pursuant to section 34-325-11Z,C.R.S.,of the Colorado Land <br /> Reclamation Actfor the Extraction of Construction Materials Any alteration or'modification of this form shall result in voiding any <br /> permit issued on the altered or modified form and subject the operator to cease and desist orders and civil penalties for operating <br /> without a permit pursuant to section 34-32.5-123. CRS, <br /> Signed and dated this 7 day of //e7( , 2 DZLI . <br /> Kremmling All Seasons Rentals LLC If Corporation Attest(Seal) <br /> Applicant/Operator or Company Name <br /> Signed: • /��/ Signed: <br /> Corporate Secretary or Equivalent <br /> Title: Owner Town/City/County Clerk <br /> State of elorodO ) <br /> //�� � )ss. <br /> ( <br /> County of Ar d.. ) <br /> The foregoing instrument was acknowledged before me this 7 day of may , <br /> o q_,by rn1;-1ch Loci<heir+ as OLi)Meir of }�Cernm I iA-1 I <br /> Seasc ns �Re Mals LLC <br /> Martha F Schake nrICiA hCrca Se.ha a_ <br /> NOTARY PUBLIC <br /> STATE OF COLORADO Notary Public <br /> NOTARY ID# 19874178644 <br /> MY COMMISSION EXPIRES 0913012027 <br /> My Commission expires: 09/30/40O3'7 <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 />