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- 6 - <br />12 <br />t,ernncanon: Division of Minerals and Geology <br />As an authorized representative of the applicant, I hereby certify [hat the operation described has met the minimum requirements of [he <br />following terms and conditions: <br />1. All necessazy approvals from local government have been applied for (Section 34-32.5-110(1)(a)(viii). <br />2. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence at the time this <br />application is filed, and located within 200 feet of the proposed affected azea have been identified in this application (Section 34-32.5- <br />] 15(4)(e), C.R.S J. (NOTE: For 110 operations, the affected azea includes all lands delineated by the permit boundary) <br />3. No mining operation will be located on lands where such operations aze prohibited by law (Section 34-32.5-115(4)(£), C.R.S.). <br />4. As the applicanUoperator, I do not have any mining/prospecting operations in the State of Colorado currently in violation of <br />the provisions of Ute Colorado Land Reclamation Act for the Extraction of Constructionlviaterials (Section 34-32.5-120, C.R.S.). <br />5. I understand that statements in the application aze being made under penalty of perjury and that false statements made herein <br />aze punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S 1984. <br />Signed and dated this 12 day of AP1tIL <br />Fremont Board of._County Commissioners <br />Applic/an//U/~Operator ////~,n/ <br />Signed: tv L~1 ~ ~ ~-~~p~~~J <br />Title: Chairman <br />Sla[eof Colorado ~ <br />_ _.) ss. <br />County of Fremont 1 <br />The foregoing instrument was acknowledged before me this <br />James R. Schauer <br /> ,,,; <br />r- A/~~ <br />~ <br /> r <br />~' <br /> <br />_' <br />\ ~ f <br />, <br />~ <br />. ~ '.~Nr <br />5 <br />i <br />~' , <br />- <br />ce.. _ <br />~ ` <br />'?iArlfr.....~. . _ <br />as Chairman <br />~: <br />RECE~~~ ED <br />M,~,Y 2 c1 1002 <br />of Fremont County <br />i\ /A/AA -_~ / / <br />o ary Public -d <br />My Commission expires: ~- 6 -aov~ <br />SIGNATURES MUST BE IN BLUE INK <br />2002 <br />L` Corporation Attest (Seal)_ _ ' <br />Sign / ` - <br />Corporate Secaz or Equivalent <br />- ~~.-- <br />dnumlGitylCoun[y Clerk <br />day of ~- April 2002 by <br />M:UIIMSHARE\VSFORMS\2821CO10.APP 10/15/01 <br />