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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 />1. All necessary approvals from local government have been applied for (Section 34-32.5-110(I)(a)(viii). <br />2. To the best of my knowledge, all si„enificant, valuable and permanent man-made structure(s) in existence a[ [he time [his <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 />115(4)(e), C.R.S.). (NOTE: For 110 operations, the affected azea includes all lands delineated by the permit boundary.) <br />3. No mining operation will be located on lands where such operations are prohibited bylaw (Section 34-32.5-115(4)0, C.R.S J. <br />4. As the applicandoperator, I do not have any mining/prospecting operations 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.R.S J. <br />5. I understand that statements in the application are being made under penalty of perjury and that false statements made herein <br />aze punishable as a Class 1 misdemeanor pursuant [o Section 18-5-503, C.R.S 1984. <br />Signed and dated this ~_ day of ~ L\/ ~ ~a _. <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of <br />ss. <br />County of i_&e fkE ) <br />The foregoing instrurrlent was acknowledged before me [his ~a__ day of v~ , ~L, by <br />~NNIS (,t),~ I`~2 as ~~ ~'~ of ~' ~fC- . `~ , <br />., =, i ~ yf ~ ^ c My Commij`"'s`s/io/n expires: ~ ~ `~ ~ ~ ~ <br />c <br />`~~~~~~ i~~~~~^~ SIGNATURES MUST BE IN BLUE INK <br />;E~VSFORMS~2821CO10.APP 10/15/Ol <br />Title: ~/Q~/3L~ ~~ <br />