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<br />- ~ - <br />Certification: <br />As an authorized representative of the applicant, l hereby certify that the operation described has met the minimum <br />requirements of the following terms and conditions: <br />1. To the best of my knowledge, 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.R.S.), <br />2. No mining operation will be located on lands where such operations aze prohibited by law (Section <br />34-32.5-1 t 5(4)(f), C.R.S.: <br />3. As the applicanUoperator, I do not have any extraction exploration operations in the State of Colorado currently in <br />violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials (Section <br />34-32.5-120, C.R.S.) as determined through a Boazd finding. <br />4. I understand that statemenu in the application aze being made under penalty of perjury and that false statemenu <br />made herein aze punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. <br />Signed and dated this day of <br />Northern Colorado Constructors, Inc <br />n~grAq?;•P n; v; s; on <br />ApplicanUOperator or Company Name <br />Signed: <br />Title: President <br />If Corporation Attest (Seal) <br />Signed: Q' <br />Corporate Secrets r Equivalent <br />State of ~c~cpt_2~ ) <br />ss <br />County of l~%~a1 ) <br />Town/Ciry/County Clerk <br />The foregoing instrument was acknowledged befo~re~/me this _~2~tt~ day of ~iY~~ Z-~l <br />by ~Oat~1 ~Q~L"~-C~ as Y:~i2~c''n"!-. Jt' of~~f~//i'rnl. /'~i"~ts/d~, ~~rCG~~./t <br />Notary PyKlic <br />My Commission expires:,- >C ZCJ`--' <br />SIGNATURES MUST BE IN BLUE INK <br />M:N9N~SW~RE\VSFORMS~2823C012.APP OL IO/99 <br />