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-~- <br />Certifieatioa: <br />• an authorized representative of the applicant, I hereby certify that the operation <br />described has met the minimum requirements of the following terms and conditions: <br />1. To the best of my knowledge, all significant, valuable and permanent man-made <br />structure(s) in existence at the time this application ie filed, and located within 200 <br />feet of the proposed affected area have been identified in this application (Section 34- <br />32.5-115(4)(e), C.R.S. ). <br />2. No mining operation will be located on lands where such operations are prohibited by <br />law (Section 34-32.5-115(4)(f), C.R.S.; <br />3. Ae the applicant/operator, I do not have any extraction/exploration operations in the <br />State of Colorado currently in violation of the provisions of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-120, C.R.S.) <br />ae determined through a Board finding. <br />6. I understand that statements in the application are being made under penalty of <br />perjury and that false statements made herein are punishable ae a Class 1 misdemeanor <br />``:. • ' , <br />pursuant to Section 18-8-503, C.R.S. -".,'-`'~;. <br />` ~ •. <br />Signed and dated this _ ~~~k day of ~/C/[~ ZoaO _ - ~~-• -. _ <br />Applic~ant/operat r <br />sned: 7/ 0"7~ <br />Title: ~Fi,~'Cz~>fTL~ ~7~/iUi~/5T,[~.fiz.~/ <br />State of L~Lr.~.?~U ) <br />) ss <br />County of ~2 ~~..0 ) <br /><%.'~_.~ <br />If Corporation Attest (Seal) ~''i~ ~''~r ' ~~ <br />"'rq~...., '.' "' <br />Signed: <br />Corporate to or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this ~ day of ~~G/L Z«d , <br />by l T~ . ~/7`i ill: <br />'; .;^. <br />01/62/96 ~23FC0.112 <br />,/ <br />as }76U/~~~LY/G i`K/i'11i.1/ . of <br />i <br />Notary P i <br />?fy commission expires: a r <br />r 1 <br />