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<br />-4- <br />As an authorized representative of the applicant, I hereby certify that the operation <br />described herein has met the minimum requirements of the following terms and conditions: <br />1. phis mining operation will not adversely affect the stability of any <br />significant, valuable and permanent man-made structure(s) located within <br />two hundred (200) feet of the affected lands. However, where there is an agreement <br />between the applicant/operator and the persons having an interest in the structure <br />that de~mage to the structure is to be compensated for by the applicant/operator <br />(C.R.S.. 34-32-115(4)(d )), then mining may occur within 200 feet. Proof of an <br />agreement rnrst be submitted to the Division prior to the decision date. <br />2. No mining operation will be located on lands where such operations are <br />prohibited by law (C.R.S. 34-32-115(4)(f)); <br />3. 11s the applicant/operator, I do not have any mining/prospecting operations in <br />this State of Colorado currently in violation of the provisions of the Mined Land <br />Reclamation Act (C.R.S. 34-32-120) as determined through a Board finding. <br />4. I understand that statements in the application are being made under penalty <br />of perjury and that false statements made herein are punishable as a Class 1 <br />misdemeanor pursuant to Section 18-8-503, C.R.S. <br />Signed and dated this .21~ ~ day of ~. <br />KIOWA COUNTY, COLORADO <br />Applicant/Operator <br />By. at' on B~ y <br />Ti t7 e: Chairman, Board of ounty <br />-eon~ssnmers <br />If Corporation Attest (Seal) <br />BY: _ c..~ <br />Corporate cretary or Equivalent <br />Town/City/County Clerk <br />State Of S;olorado } <br />} ss <br />COUnty Of F;iowa } <br />The foregoing instrument was acknowledged before me this~tJ~day of rune 91 . <br />by Cordon Berr v a5 Chairman Of Hoard of C.nnnry r„mm; ~~;,,..Prs <br />(.J ' <br />Notary P lic <br />My Commission expires: /0- 3 -- 9 ~ <br />2823F (03/gl ) <br />