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'~'~ • • <br />- 6 - <br />Certification: <br />As an authorized representative of the applicant, 1 hereby certify that the operation described has met <br />following terms and conditions: <br />All necessary approvals Gom local government have been applied for (Section 34-32.5-I 10(I)(a)(viii). <br />.- ; <br />the <br />2. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence a[ the time this <br />application is filed, and located wlthm 200 feet of the proposed affected area have been identified in this application <br />(Section 34-32.5-I l5(4)(e), C.R.S.). (NOTE: For I IO operations, the affected area includes all lands delineated by the pemut <br />boundary.) <br />No [Wining operation will be located on lands where such operations aze prohibited by law (Section 34-32.5-1 I5(4)(f), C.RS.). <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 perjure' and that false statements made herein <br />are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS 1984. <br />k\ <br />Signed and dated this ~ day of ~ a- <br />ApplicanUOperator <br />Signed: AIL L.. 1 I_ ~~ <br />Title- Ertl- ~- fi~ave. ~ Q ~ ,.r ~'' <br />State of ~ ) <br />~) ss. <br />County of ~-v <br />The gom mstrument was acknowledged before me this <br />~ip•1fL?~L.~ Y n~-vu*~~ as <br />o , ~,c, <br />• EILEEN M, <br />_ ZUBAL <br />s~ .,. <br />'`Qf OF <br />7„~~ ~ <br />. - .,, <br />. ', <br />cam' =_~ ~''; <br />If Corporation .gtt~f (~al~ '; ,~' <br />3i' v.`' ~ <br />Signed <br />Corporate Secretary or Equivalent <br />Towv/City/County Clerk <br />„~%l~~ ~ Q?ddlJ , by <br />~ of ~~o.E'~ ~ 04„ <br />Public v <br />Commission expires: ~`' d a d y 2 <br />SIGNATURES MUST BE IN BLUE INK <br />M:\MIMSI-TARE\VSFORMS\2821COIOAPP 06/25'99 <br />