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- 6 - <br />CertiScation: <br />As an authorized representative of the applicant, 1 hereby certify that the operation described has met the minimum requirements of the <br />following terms and conditions: <br />All necessary approvals from local government have been applied for (Section 34-32.5-110(1)(axviii). <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 34-32.5-1 I5(4xe), C.R.S.). (NOTE: For 1 10 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(4xf), 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. I 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 ] 8-8-503, C.RS 1984. <br />Signed and dated this 7 ~~ day of <+ ~ , ,~. <br />_~G.S ~nl.n a J ~o tan f~ <br />Applicant/Operator <br />[f Corporation Attest (Seal) <br />Signed: ~ /S~- (~~ <br />Title: 1~i~rc7~i' aF ~/Gn,~i~7 <br />State of Colorado <br />) ss. <br />County of Las Animas ) <br />Sige~,iD1~S4~301>n,Q,E~.~ ~~~X'~--- <br />Corpora eSecretary or Equivalent U <br />Tewa~CitylCounty Clerk <br />The foregoing instrument was acknowledged before me this ~ th day of May 1999 by <br />Robert A. Lucero ~ Director of Planning of Las Animas County <br />Bernard J. Gonzales as County Clerk of Las Animas County. <br />Notary Publi <br />My Commission expires; <br />SIGNATURES MUST BE IN BLUE INK <br />M:Vd INISHARE\VSFORMS\2R21COIO.APP 02/10!94 <br />1217J2000 <br />FAYE CORUOVA <br />18050 HWY 12 <br />WESTON, CO 81091 <br />