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— 6 — <br /> Certification: <br /> As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements of the <br /> following terms and conditions: <br /> I. All necessary approvals from local government have been applied for(Section 34-32.5-1 10(1)(a)(viii). <br /> 2. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence at the time this <br /> 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.). (NOTE: For 110 operations, the affected area includes all lands delineated by the permit <br /> boundary.) <br /> 3. No mining operation will be located on lands where such operations are prohibited by law(Section 34-32.5-1 15(4)(f), C.R.S.). <br /> 4. As the applicant/operator, I do not have any mining/prospecting operations in the State of Colorado currently in violation of <br /> the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials(Section 34-32.5-120,C.R.S.). <br /> 5. 1 understand that statements in the application are being made under penalty of perjury and that false statements made herein <br /> are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503,C.R.S 1984. <br /> Signed and dated this S day of ` r7 <br /> No 56�zL <br /> 5 050& M l,V erZA-t—S If Corporation Attest(Seal) <br /> Applicant/Operator <br /> Signed: Siged: <br /> Corporate Secretary aquivalent <br /> Title: P2ESIbGNT Town/City/County Clerk <br /> State of CC.t_O6MQ ) <br /> ss. <br /> County of .rJrO147 ) <br /> The foregoing instrument was acknowledged before me this day of ri /7 9' . by <br /> R,kY tot-s6y p��s �,� r of slEc�fi n,�rx�cs <br /> 4, 1.. % <br /> Notary Public <br /> My.Commission expires: q—o-ZUd z <br /> SIGNATURES MUST BE$N'BLUE INK - <br /> M:V.tQJ HAR.E\VSFORMS\2821COIO.APP 02/10/99 <br />