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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 34-32.5-1 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 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.,of the Colorado Land <br /> Reclamation Act for 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,C.R.S. <br /> Signed and dated this 3o day of Jgh , 202 6 <br /> Northern Colorado Constructors, Inc. <br /> If Corporation Attest(Seal) <br /> Applicant/Operator or Company Name <br /> n f I .� , <br /> Signed: C �cJ��e�ORgs/.6G. Signed: 3.-._, <br /> V: SEAL ;�: Corporate Secretary or Equivalent <br /> SEAL <br /> Title: ���s '� �y';C) Q 0; Town/City/County Clerk <br /> 4•SORp <br /> State of 0_6(0VcLo10 ) '''��tttt*t��`0%`` <br /> `` 11 '' )ss. <br /> County of W t.iA <br /> The foregoi instrument was acknowledged before me this 3 6 day of vavtu VV <br /> , by iJ5/`S as Tye id u✓P be" of 1V i✓f-Li e/n C of o✓qri o <br /> Cons itt vs, <br /> LIZZZIA-- - a <br /> MEL A A ORD Notary Public <br /> NOTARY PUBLIC <br /> State of Colorado <br /> Notary ID#20074038662 My Commission expires: l) /�U <br /> My Commission Expires 10/14/2027 <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 />