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-7- <br />As m authorised reprdmtative of the applicant, I hereby citify that the opaatios described has met the minimum <br />requirements of the following terms end amditioaa: <br />1. To the beat ofmy Imowladge, all sigaificmt, valuable cod pennesast mao-made strucutne(s) in erdsOmoe at rho time <br />this application is Steil. and located within 200 ftd of the proposed affaxed area have been identified in this applicatim <br />(Soctim 3432.5-115(4Xe), C.RS.). <br />2. No mmisg operefiao will be bcatod on ~ where sorb operatianv are prohibited by law (Berrien <br />3432.5-113(4xfl, CRS.; <br />3. As the app6oarlNapaetor, T do not have coy extrachionlexpbration operstiasa inthe State of Cokxado conraUy is <br />violation of the proviaioss of the Colorado [.end Rerlama<ian Act fa the F.xtraaien of Construction Materiels (Section <br />3432.5-120, CRS.) as detam~od through a Baud finding. <br />4. I uode~d that afatem~ m the application ate being made tu(der pemtty of perjiay end that false ststemmfs <br />made herein are p(miabable as a Clma 1 miadeamanor pmsuard w Betties 18-8-503, C.RS. <br />Signed eaddated this / 1 ~ day of ~ a-~1 <br />Seifert Construction <br />ApplicaotlOperatarannCompesyN -~ <br />.P~ <br />Signed: ~~ <br />Tide: Sole Propreitor <br />State Of \~ (O f G ~ O ~ <br />Canty of C~ S ~2 t ~ ~. <br />If Corparetim Attu (Seal) <br />signori: <br />Carparate Secretary a• Eq(dvalem <br />Town(City/Canty Clerk <br />The foregoing was aclmowledged before me this ~ it ~ dsy of <br />jQ.rc.ic~ ~P,-rat as~~,¢.mbe ~' of <br />My Commission Expires 06/09/2007 <br />My Cammissicn axpites: (a-~1- 01 <br />SIGNATURES MUST BE IN BLUE INK <br />Mdau'.Cmoumm 112doe (10'1Y2001) <br />