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-6- <br />Certification: <br />?.s an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements of <br />the 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 lmowledge, 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 34-32.5-115(4)(e), C.R.S.). (NOTE: For 110 operations, the affected azea includes all lands delineated by the <br />pemut boundary) <br />3. No mining operation will be located on lands where such operations are prohibited bylaw (Section 34-32.5- 115(4)(f), <br />C.R.S.). <br />4. As the applicandoperator, I do not have any mining/prospecting operations in the State of Colorado currently in <br />violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials <br />(Section 34-32.5-120, C.R.S.). <br />5. I understand that statements m the application are being made under penalty of perjury and that false statements made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. 1984. <br />Signed and dated this ~ day of <br />Applicant/C)perator <br />Signed: <br />Title: ~p U~~~ .. <br />State of ~--O~t~'J ) <br />p ) ss. <br />County of C,1 __ c (.~..~ ) <br />T'he foregoing instrument was aclrnowledged before me this 5~` day of <br />~r~B~ak~ as ~••a Usc. Ad ~-..; .,ts~, der of <br />If Corporation Attest (Seal) <br />Signed: u.calr-/~- <br />Notary Public <br />secretary or t;qutvatent <br />r>~ounty ~lerk <br />:-. <br />'~: : ~~ <br />,~,bY <br />My Commission expires: ~~ _ ~ ~F _ aoo~ <br />SIGNATURES MUST BE IN BLUE INK <br />M:lmin~shaze\vsfmms\ConsWCtionl l0 (05/06/2003) <br />