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_•' .. <br />-6- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described <br />has met the minimum requirements of the following terms and conditions: <br />1. All necessary approvals from local gavernmeat have been applied for <br />(Section 36-32.5-110(1)(a)(viii). <br />2. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) <br />in existence at the time this application is filed, sad located within 200 feet of the <br />proposed affected area have been identified in this application (Section 34-32.5-115{4)(e), <br />C.R.S.). (NOTE: For 110 operations, the affected area includes all lands delineated by the <br />permit boundary. ) <br />3. No mining operation will be located on lands where such operations are prohibited by law <br />(Section 34-32.5-115(4)(f), C.R.S. ). <br />4. As the applicant/operator, I do not have any mixing/prospecting operations in the State <br />of Colorado currently in violation of the provisions of the Colorado Laad Reclamation Act for <br />the Extraction of Construction Materials (Section 34-32.5-120, C.R.S. ). <br />5. I understand that statements is the application are being made under penalty of perjury <br />and that false statements made herein are punishable as a Class 1 misdemeanor pursuant to <br />Section 18-8-503, C.R.S 1984. <br />Signed and dated this ~~ day of / l~ ~ +~~ , / 2~. <br />.C AS An%M~s ~OL.n7~~, <br />Applicant/Operator <br />Signed: ~n-b~t,Y ''4lJ~LG~i~ <br /> <br />State of ~A~a~o c~G ) <br />ss <br />County of .~cs 1f~i~"+GJ' ) <br />The foregoing iitst*'++~++t was acknowlnnedged before me this day of ~~, ~ ~• <br />by ~C o beL' t ~- ~.U cQ ,eo as (,v v,/f ~ ~~ ~N/1/e.e of ~l~S itn~ ~~/h ~ S CDuN1y <br />by ~e ~e~,~e~ s. GoNz,.+~e Z as <br />oi/az/z ~sur-oo_uo <br />If Corporation Attest (seal) <br />Sigaed:~* d~eSCL~2t_~~C~~~ <br />Corporat Secret or 8quivalen <br />~oava~2itr/County Clerk <br />SIGNATURES MOST HS IR BLIIE INK <br />~{!'Y€ CQRDOVA <br />i@@~8 Nwv 1z <br />~§~ CQ 87091 <br />My Co®ission expires: <br />