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1 <br />• ~ • <br />- 6 - <br />~"`erti~ fication: - <br />As an authorized representative of the applicant, I hereby certify that the operation <br />described has met the minimum requirements of the following terms and conditions: <br />1. All necessary approvals from local government have been applied for <br />(Section 34-32.5-110(1)(a)(viii). <br />2. To the best of my knowledge, all significant, valuable and permanent man-made <br />structure(s) in existence at the time this application is filed, and located within 200 <br />feet of the proposed affected area have been identified in this application (Section 34- <br />32.5-115(4)(e), C.R.S.). (NOTE: For 110 operations, the affected area includes all lands <br />delineated by the permit boundary.) <br />3- No mining operation will be located on lands where such operations are prohibited by <br />law (Section 34-32.5-115(4)(f), C.R.S.). <br />4. As the applicant/operator, I do not have any mining/prospecting operations in the <br />State of Colorado currently in violation of the provisions of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-120, <br />C. R.S.). <br />5. I understand that statements in the application are being made under penalty of <br />perjury and that false statements made herein are punishable as a Class 1 misdemeanor <br />pursuant to Section 18-8-503, C.R.S 1964. <br />Signed and dated this ~_ day of 1-/_-7--~-- <br />COSTILLA COUNTY <br />Applicant/Operator ~ ,,L- ///~~ <br />Signed:/ ~l/..,•~.'iJ ~~i/~.-// 4~[~~'7l' .~' s.~~~ <br />L <br />Title: COIINTY AIIMTNTSTRATf1R <br />State of fill f1RAfl0 ) <br />ss <br />County of f.OST I LI A ) <br />The foregoing i//n~~strument was ac~,kyn/owledged before me this ~Qdaynof( /~ /~, ~~~/, <br />by ~Y~NGGS ,C~r~2R 6e~~. a~ ~ of I~~S/.(~µ (~Qw~y <br />,01,/,,lti a `~' ~~.e.. ~ ~ / /... ' . _'/_ ., ~ . <br />2 <br />n/ <br />04/25/97 2821FC0.110 <br />If Corporation Attest (Seal) <br />Signed: ~ ~ <br />Corporate Secretary or Equiv nt <br />Town/City/County Cler <br />My <br />SIGNATURES MUST HE IN BLTJE IN& <br />S, NOtar$~ <br />- Public <br />3- <br />ai .1 <br />ex <br />ires: <br />~hi ~ ~ o2 Qa ~ <br />p <br /> ,.,,gnu w,,,,. <br /> <br /> <br /> <br /> <br /> ~ l . <br />:~n: p ~ io <br /> : <br />v-~~ <br />~; s <br />P~4,; <br /> , <br />o <br />t <br /> <br />