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-G- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements <br />of 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 <br />this application is filed, and located within 200 feet of the proposed affected area have been identified in this application <br />(Section 34-32.5-115(4)(e), C.R.SJ. (NOTE: For 110 operations, the affected azea includes all lands delineated by the <br />permit boundary.) <br />3. No mining operation will be located on lands where such operations aze prohibited bylaw (Section 34-32.5-I 15(4)(f), <br />C.R.S.). <br />4. As the applicant/operator, 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 (Section 34- <br />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 <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. 1984. <br />Signed and dated this / ~ day of ~~~~.~ a ~ ~ 3 <br />(~yf Cuyta NT C-'Z~3 ti.1T~ <br />ApplicandOperator <br />Signed: y ~ ~ ~ Signed:', <br />Tille: C~-AiAeNA~ <br />If Corporation Attest (Seal) .. <br />-- - <br />of 'L : ., <br />TewniEityfCounty Clerk <br />State of Co~Qad» ) <br />ss. <br />County of r'Rt.aAa...i ; <br />The foregoing instrument was acknowledged before me this /~ day of , a~ ?,_, by <br />rYK~.t... v~ii'~.fi~Erte as C+t>4..QMAN of ~PF..uanlr l',cyR(rV <br />r /- 'Q <br />~._~,- _~---'~,,~~~ c~ ~oc~u7y Cl.o~hht0.5 <br />c ~ .~._ =_ a ~otaryr~nonc. <br />%'i~----- - ~~% o: ` My Commission expires: 7 - zE~ - 06 <br />i~ ~ .~-. ^~. pC <br />SIGNATURES MUST BE IN BLUE INK <br />