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~ M <br />- ~ - R~CF~~FD <br />MqR <br />Certification: ~8 ?QQQ <br />w°~ °rMr~rab <br />As an authonzed representative of the applicant. I hereby cettify that the operation dzsenbed has met the minimu~~ments of the <br />follo[[ing terms and conditions' <br />All necessan approvals Gom local goccmment have been applied for (Section 3-4-=?5-I !O(1)(a)(~iii). <br />2. To the best of me 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 hate been identified in this application <br />(Section 34-325-I I5(4)(e). C.R.S.j (NQTE: For 1 l0 operations. the affected area includes all lands delineated b_v the permi[ <br />boundary'.) <br />3. No mining operation will be located an lands where such operations arz prohibited be law (Section 34-32.5- 115(4)(f), C.R.S.). <br />4. As the applicandopera[or, I do not have any tninine/prospecting operations in the Slate oCColorado currenth' in violation of <br />the provisions of the Colorado Land Reclamation Act for the Extraction of Construction titaterials (Section 34-.2.5-120, C.R.S.). <br />5. I understand that statements in the application are being made under penalty of perjure and that False statements made herein <br />are punishable as a Class l misdemeanor pursuant to Section 18-8-50., C.RS 1984. <br />Signed and dated this ~ ~ ~ day' of / 6' <br />~pJo <br />Applicant/Operator <br />Signed: A <br />Title: L O Kr r"t i 5;•~ o ,r ~ ~ <br />State of Cnh2cc<•l., ) <br />) ss. <br />Countvof hati a ~r„ w 1 <br />If Corporation Attest (Seal) <br />Signed: ~ ~~-,i- <br />Eo ket~ <br />Tovv Clerk <br />The foregoing instrument was acl~[owledged before me this olo ~`~ day' of ~~- -~.-~-R. , ~~c< <, , b}' <br />~:2n_.t Ile.., as ~yuw~~y C~.,,n.;SS.;,,,e~~ Of ~%lY~eirir~ <br />r ~. ~ . <br />":. _ <br />^' <br />• .'H,-;` <br />l ". ," ~: ;'. ~n SIGNATURES ivtUST BE IN BLUE INK <br />VIiM[N~SFWRE\VSFOR~\1S'?3'_ICOIO.APP 06•_x.99 <br />