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<br />- 6 - <br />Siged: ,~{~, ~ Q@4~Pd) <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 necessary 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 area have been identified in this application <br />(Section 34-32.5-11 S(4xe), C.R.S.). (NOTE: Fot 110 operations, the affected area includes all lands delineated by the permit <br />boundary.) <br />3. No mining operation will be located on lands whcae such operations are prohibited by law (Section 34-32,5-115(4)(fj, C.R.S.). <br />4. As the applicant/operator, I do not have any mining/prospectingoperertions in the State of Colorado currently in violation of <br />the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-120, C.RS J. <br />5, I understand that statements in the application are being made under penalty of perjury and that false statements made herein <br />are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS 1984. <br />-f~ ,// ~~ <br />Signed and dated this 7i7 day of 7 7 ~!r;~ 2 <br />B~' If Corporation Attest (Seal) <br />Applicant/Operator <br />Signed: `%' / /~ ~~,~~e! ll.Y/' ~ti <br />Title: ~.it O.~~ildfr~ <br />State of C::.,o r^~a <br />` ss. <br />County of SJ M x\ t ) <br />The foregoing innnstru Ament was acknowledged before me this l 2'7 <br />,~~~ ~ ti f. <br />~n~~~v <br />x^ __ -, <br />-_ `; „ r- <br />. r""^ <br />..., ~. `: <br /> <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />day of ~,~s~ ~ ° 1 by <br />of <br />~~~ <br />Notary Public <br /> <br />My Commission expires: MY Commission Expires <br />-'~'f07'1004 <br />SIGNATURES MUST BE IN BLUE INK <br />02/10/99 <br />