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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. This 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 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 Host be submitted to the Division prior to the decision date. <br />2. Vo 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. ,4s the applicant/operator, I do not have any mining/prospecting operations in <br />this State of Colorado currently in vio]ation of the p+~ovisions of the (dined Land <br />Reclamation Act (C.R.S. 34-32-120) as determined through a Board finding, <br />~. I understand that statements in the application are being made under penalty <br />of perjury and that false statements ~~ade herein are punishable as a Class 1 <br />misdemeanor pursuant to Section 18-8-503, C.R.S. <br />Signed and dated thi s Z ` day of ~,¢,~ ~ ,~ 9 / . <br />WC57-ca./ ~sea~s,v.res, ~c <br />Applicant~/Operator <br />If Corporation Attest (Seal) <br />3y: ~ / ~~~ <br />Q'//or~porate Secretary or Equi ent <br />Town/City/County Clerk <br />State of C9.~1'Ad0 ) <br />ss. <br />County of _ ~ ~ ) <br />The foregoi'ag instrument was acknowledged before me this •~~~day of ,nQc- , ~~, <br />by a s Ul' c ~~~.u22 "i ~~~ ,, o f 7 <br />i <br />No tar Public <br />• My Commission expires: 1~/~ <br />2823F {03/91 ) <br />