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~I <br />-4- <br /> <br />7. The mining operation will not adversely affect the stability of any <br />significant, valuable, and permanent man-made structures located within two hundred <br />(200) feet of the affected lands, except where there is an agreement between the <br />applicant/operator and the persons having an interest in the structure, that damage <br />to the structure is to be compensated for by the applicant/operator <br />(C.R.S. 34-32-115(4)(d )), then mining may occur within 200 feet. Proof of an <br />agreement rtust be submitted to the Division; <br />8. No mining operation will be located on lands where such operations are <br />prohibited by law (C.R.S. 34-32-115(4)(f)); <br />9. The mining operation will be conducted in accordance with the terms and <br />conditions listed in the application (Rule 3.3 (1)(b)); <br />10. As the applicant/operator, I do not have any mining/prospecting operations in <br />this state of Colorado currently in violation of the provisions of the Mined Land <br />Reclamation Act (C.R.S. 34-32-120) as determined through a Board finding. <br />11. One complete copy of the application form and all exhibits, together with any <br />supplemental information provided by the applicant/operator to the Division has <br />been provided to the County Clerk and Recorder for each county in which affected <br />lands will be located (Rule 3.3(3)(a)); and, <br />12. I understand that statements in the application are being made under penalty <br />of perjury and that false statements made herein are punishable as a Class 1 <br />misdemeanor pursuant to Section 18-8-503, C.R.S. <br />Signed and dated this ~ day of 1~~L• - <br />App t/Operat r ~ If Corporation At est (Seali <br />Title: / Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of j'-(/~~(~(j - ) <br />ss <br />County of ',~ cZ/ ) <br />The foregoing instrument was acknowledged ~be,/foreLme this~~ day of _. ~, <br />by as _ /~er1 cCL,2tiLC. o ~ ~ °,1 fiKi ;,~ <br />n .,c~~ <br />Notary Public <br />2820E (03/91) My Commission expires: ~~ - ~~ .~ <br />