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<br />-~- <br />t Certification: <br />As an authorized representative of tfie applicant, I hereby certify that the operation described has met the minimum <br />requirements of the following terms and conditions: <br />' l . To the best of my 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-I IS(4xe), C.R.S.). <br />' 2. No mining operation will be located on lands where such operations are prohibited by law (Section <br />34-32.5-I I5(4)(f), C.R.S.: <br />3. As the applicanUoperator, l donor have any extraction/exploration operations in the State of Colorado currently in <br />violation of the provisions of the Colorado Land Reclamazion Act for the Extraction of Construction Materials (Section <br />' 34-32.5-] 20, C.R.S.) as determined through a Board finding. <br />4. 1 understand that statements in the application are being made under penalty of perjury and that false statements <br />' made herein are punishable as a Class I misdemeanor pursuant to Section 18-8-503, C.R.S. <br />Signed and dated this day of <br />' Northern Colorado Constructors, Inc <br />j~i.rtrcc~ara n;vicion If Corporation Attest (Seal) <br />ApplicanUOper/a~t"or or Company Name ~ <br />' Signed: / Signed: `_~ 1 iL] ' ~ l <br />' Corporate Secret or Equivalent <br />Title: President Town/City/County Clerk <br />' State of (~~~~/~i ) <br />1 ) ss ' <br />County of L/%~~ ) <br />' The foregoing instrument was acknowledged befo~re~/me this ~ day of ~ir~~~ ~~° , <br />by ~Oisr~i r Z11~-~ ~ as Y".~2~~~ 1` of -~~ ~q pf~t~ v ~ v~~~Fi'~ <br /> <br /> <br /> <br />Notary P lic <br />My Commission expires: ~~ ZLY>~~ <br />SIGNATURES MUST BE IN BLUE INK <br />' M:N9MSHARE\VSFORMS~i8I1C013.MP 07/IQ'99 <br />