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-~- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has me[ the minimum <br />requirements of the following terms and conditions: <br />1. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence at the time <br />this application is filed, and located within 200 feet of the proposed affected azea have been identified in this application <br />(Section 34-32.5-115(4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations aze prohibited bylaw (Section <br />34-32.5-115(4)(f), C.RS.; <br />3. As the applicant/operator, I do not have any extraction/exploraGon operations in the State of Colorado currently in <br />violafion of the provisions of the Colorado Land Reclamation Act for the Extraction of Construcfion Materials (Section <br />34-32.5-120, C.RS J as determined through a Boazd fording. <br />4. l understand that statements in the application aze being made under penalty of perjury and that false statements <br />made herein are punishable as a Class ]misdemeanor pursuant to Section 18-8-503, C.RS. <br />Signed and dated this J I day of ~~~~i;~- r ---~~ ~U <br />If Corporation Attest (Seal) <br />ApplicantlOperator or Co pony Name <br />Signed: `~~~ Signed: <br />Corporate Secretary or Equivalent <br />Title: ~~~.lih-1' Town/City/County Clerk <br />State of ~ /D /2r. c '~ ) <br />ss <br />County of .i/~~_ ) <br />The foregoing instrument was acknowledged before me this ~ day of - ~~ ~ 3, <br />by f ~ 1 ~ ~ ~ i dir-y. ~ _ 1°eP ~Z-- as /YL of 1 ~1r~}~i~ ib ~C <br />~`~°~_ ~oygN <br />v'.• ~~r.a q ••.'y <br />..~ y . <br />Notary Public <br />9, •o~e L`G,: op My Commission Expires <br />JF •., ,. •Q,P 9.29-2005 <br />~F Co~~ My Commission expires: <br />SIGNATURES MUST BE IN BLUE INK <br />~ai~Ai <br />