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0~~~~1~Fn <br />~~ 2 4 19,96 <br />-4- Division of m~nerais d ~eoloyy <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. This mining operation will~not adversely affect the stability of any _ <br />significant, valuable and permanent man-made structure(s) located within <br />twv 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 damage 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 mist be submitted to the Division prior to the decision date. <br />2. No mining operation will be located on lands where such operaricns are <br />prohibited.by law (C.R.S. 34-32-115(4)(f)); <br />3. As the applicant/operator, I do not have any mining/prospecting operations in <br />this State of Colorado a rrently 1n 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 artd dated this /~_ day of , _ d_ 9~ <br />Sn',.~a~Lta r^ou~fff /~~a~an~~i~,il9e. <br />Applicant/Operator <br />If Corporation Attest (Seal) <br />BY ~ 115 ~ ~(l O_ <br />Title: e~~.,.~.i F ,,,,,~„. <br />State of (~AQ~„o.,Q,~ ) <br />ss <br />County of ) <br />By: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this <br />by 5~3-~ -gip Fo,1-.-~-n,. = <br /> ~. ~ <br />2823E (01/91) <br />of <br />1? day of ~°- ~, ~ <br />7 ~~ V""~`~ L Vl <br />. ~ ~ ~- <br />'1~-tar~Pir~i ~ ~ .. <br />My Commission'-.~':~~•resTi/1 <br />~~dCU~+' <br /> <br />