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- 6 - <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements of the <br />following terms and conditions: <br />All necessazy approvals from local government have been applied for (Section 34-32.5-110(1)(a)(viii). <br />2. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence at the time this <br />application is filed, and located within 200 feet of the proposed affected azea have been identified in this application (Section 34-32.5- <br />I15(4)(e), C.R.SJ. (NOTE: For 110 operations, the affected area includes all lands delineated by the permit boundary) <br />No mining operation will be located on lands where such operations are prohibited bylaw (Secton 34-32.5-115(4)(f), C.R.S.). <br />4. As the applicant/operator, I do not have any rrrining/prospecting operations in the State of Colorado currently m violation of <br />the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-120, C.R.S J. <br />5. I understand that statements in the application aze being made under penalty of perjury and that false statements made herein <br />aze punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S 1984. <br />9f <br />Signed and dated this _~_ day of f -e <br />~hNDA~~ ~ ~abiws <br />ApplicandOperator <br />~oo~ <br />If Corporation Attest (Seal) <br />Signed: , <br />U '~'" _ <br />Ti[le:.~-ti..ctia.l. <br />State of/ ,n/or~do 1 <br />ss. <br />County of c~'1 Q/i cl C,~IC'_ ) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foreg~oin~g°instmment ~was~ acknowledged before me this ~ ~ day of Fe 6rzC~ ZDOZ?~- , by <br />~Q/h,~I.~v ~ ~~~G~M~r/1/ as ~~'V/1~Ge /~GG'z~ir+-!~P/ of ~.obl~.,o ~iikcr`urL w. LL~P <br />~ K;: <br />~` ,. . <br />,~;' <br />s. <br />- = v <br />,,,: ~,. ~ - Not Pub is <br />My Comnvssion expires: <br />SIGNATURES MUST BE IN BLUE INK <br />M:~IdIN~SFIARE\VSFORMS~2821CO10.P.PP IOft SIOI <br />