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-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 must 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. As 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 io day of S!4. <br /> Applicant/Operator If Corporation Attest (Seal ) <br /> By: By: <br /> Title: Corporate Secretary or Equivalent <br /> Town/City/County Clerk <br /> i 1 <br /> State of it �; ) <br /> f' ) ss <br /> County of c�c�VNILD ) <br /> The`-foregoing 4st.' ent was acknowled ed before �me this &'�day of <br /> by Q t .r D�P ( as ro of .R� { ee <br /> \moo �c�S" �ObUb t Q <br /> otary Publ­341 <br /> My Commission expires: - -L <br /> 2823F (01/91 ) <br />