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- 6 - <br />certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements of the <br />following terms and conditions: <br />All necessary 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 <br />(Section 34-32.5-1 li(4)(e), C.R.SJ. (NOTE: For 110 operations, the affected area includes all lands delineated by the permit <br />boundary) <br />No mining operation will be located on lands where such operations aze prohibited by law (Section 34-32.5-115(4)(f), C.RS J. <br />4. As the applicanUoperator, I do not have any minine,Jprospecting operations in the State of Colorado currently in violation of <br />the provisions of the Colorado Land Reclamation Act for the Extraction of Constmction Materials,(Section 34-32.5-120, C.RS.). <br />5. I understand that statements in the application aze being made under penalty of perjury and that false statements made herein <br />are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS 1984. <br />Signed and dated this ~~ st' day of ~ ~u _ _ _ _, ~.(~0 <br />~OC.! l ~• ~C6 ~ 1 <br />ApplicanUOperator <br />Signed: ~~ ~~ <br />Title: /9 t-f /YL1Z~~ r ~n ~~/1!/I <br />State of ~~(ora~ ) <br />County of ~~~.(~ ~_~ ss. <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this ~ ~ day of , ~, by <br />as <br />of <br />cta oar <br />~ ~ do <br />F .! ~ o Public <br />o m <br />? Q, .~~ My Commission expires: ~~ l ~c1OD J° <br />SIGNATURES MUST BE IN BLUE INK <br />If Corporation Attest (Seal) <br />Signed: <br />M:\MIN\SFIARE\VSFORMS\282ICOl0.APP 06/25/99 <br />