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-~- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum <br />requirements of the folbvving terms and conditions: <br />I. To the best ofmy knowledge, all significant, valuable and permanent man-made structure(s) in existence at the time <br />this application is filed, and located within 200 feet of the proposed affected area have been identified in this application <br />(Section 34-32.5-I15(4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited bylaw (Section <br />34-32.5-115(4)(f), C.RS.; <br />3. As the applicsrrt/operator, I do not have arty extractionlexploration 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 (Section <br />34-32.5-120, C.RS.) as deternsined through a Boazd finding. <br />4. I understand that statements in the application aze being made under penalty of perjury and that false statements <br />made herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. <br />Signed and dated this ~_ day of June 2004 't ' ~` ~:'~~., <br />~ ~-,. <br />r <br />,. - :: <br />Citv of Golden IfCorpi <br />Applicant/t~ator or Company Name <br />Signed: _~~, ' l ~~~Q Signed: <br />Title: DEPUTY 61R~cToR DF PuP,LIC lt)t7~Lg Tsx~t/City~~tmepClerl: <br />State of ~~ ~ ©('ac~0 ) <br />rte,, ,,, _ ) ss. <br />County of ~ ~T Cc-t e~ fl 1 <br />The foregoing instrument was acknowledged before me this <br />~V~nce. f~urierrr~ as~~e_a~-G~,. <br />9f ~Id~. <br />\\~.aao~o~ t do~~ %; <br />oo::'~~iand ~.: N _ No <br />- - <br />y Commission expires: -' <br />~! N <br />., yVi~. ' <br />~~iIA'IP~ MUST BE IN BLUE INK <br />M:~minWme~~damslCrmsw~tion 712.dx t1als/ZW7) ~~tlilltt <br />