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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(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 form has been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-112,C.R.S. <br /> Reclamation Act for the Extraction of Construction Materials. Any alteration or modification of this form s G <br /> permit issued on the altered or modified form and subject the operator to cease and desist orders and ci _\` 1\\' _ <br /> without a permit pursuant to section 34-32.5-123,C.R.S ,/ I f _ .. . ` -- <br /> Signed and dated this il- day of /�C 0 y 2��i <br /> L.G. Everist, Incorporated If Corporation Attest(Sea <br /> Applicant/Operator or Compano e <br /> //;g44( iill' <br /> Signed: . Signed:L kL-- <br /> Corporate Secretary or Equivalent <br /> Title: President Town/City/County Clerk <br /> State of SOi-f+1 1)Q-Kt+r-l-- ) <br /> l v`r�-htt..r va )SS. <br /> County of YY� ) 4 N <br /> Ths foregoing instrument was acknowledged before me this day of o vQ&br <br /> a(}; 5by Robert E. Everist as President of L.G. Everist, Incorporated <br /> 44.JW-0.~.02hr..frAPA4100000000' 0 jad,,,,,,-_,_ <br /> a , <br /> 14" <br /> CARRIE A. GARRY <br /> 0., <br /> NOTARY PUBLIC Qom;; Notary Public <br /> SOUTH DAKOTA�J ''J { <br /> My Commission Expires. <br /> „17,95 My Commission expires: ` I I / 0 a5 <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 />