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-- <br />.- <br />-6- <br />~: Certificafion: <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.RS.). (NOTE: For 110 operations, the affected area includes all lands delineated by the <br />pemrit boundary.) <br />3. No mining operation will be located on lands where such operations aze prohibited by law (Section 34-32.5-115(4)(1), <br />C.RS J. <br />4. As the applicant/operator, I do not have any mining/prospecting operations is 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. are 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 ~Lo day of <br /> <br />IicanUOperator: , <br />,. <br />~ ~ti~ _- <br />or.er <br />Signed: <br />Title: hac:~ County Consnissioner District #3 <br />State of Colorado <br />County of B <br />ss. <br />,~ c7 77 <br />If Corporation Attest (Seal) <br />signed: 1~,sA~.`. C~,,,,~.~c. , <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this ~ l ~ day of ~Q ,~~ , by <br />as ~p12'1 iY!//ll -inz , of l > GI <br />~_~ <br />' ~ Notary Public ~/ p <br />My Commission expires: / ' ~iT - ~~ <br />SIGNATURES MUST BE IN BLUE INK <br />tr~were~~eo~~c~a;mualtonsnootl <br />