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<br />- 6 - <br />AS an authorized representative of the applicant, ~ hereby certify that the operaticr. <br />described has met the minimum requirements of the .following terms and conditions: <br />1. All necessary approvals from local government have been applied for <br />(Section 39-32.5-110(li(a)(viii). <br />2. To tY.e best of my knowledge, all significant, valuable and permanent man-made <br />structurels) in existence at the time this application is filed, and located within 200 <br />feet of the proposed affected area have been identified in this aopl.ication (Secticn 34- <br />32.5-115(4)(e), C.R.S.). (NOTE: For 110 operations, the affected area includes all '_allds <br />delineated by the permit boundary.) <br />3. No mining operation will be located on lands where such operations are prohibi*_ed by <br />law (Section 34-32.5-i15(4)(f), C.R.S.). <br />4. As the applicant/operator, I do not have any mining/prospecting operations in the <br />State of Colorado currently in violation of the provisions of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials (Section 34-32..-i20, <br />C.R.S.). <br />5. I understand that statements in the application aze being made under penalty of <br />perjury and that false statements matle herein are punishable as a Class 1 misdemeanor <br />pursuant to Section 18-8-503, C.R.S 1?84. <br />(S~ig~ned 1an~d dated;} this urn d~a,,y,~;of <br />ICJ-11~lAAlili iL`C,l~tx~uo ~~~~"'// ~^" <br />icant/Operator <br />_, ~~• <br />/,6+~D ,t,uc~e~,~C <br />If Corporation Attest (Seal) <br />Signed: ~~r~tiI`~tf P{) ~~~~r Signed: <br />Title: ~C1~1N(;A .=''[~r``D~V1TU~ <br />State of ~~Ch~tJ ) <br />1 39 <br />County of ~~~~.~~- ) <br />Corporate Secretary or ~wivalent <br />Town/City/County Clerk <br />1c~. <br />The foregoing instrument was acknowledged before me this Z~ day of ~~, <br />y ~ a5 .~~:.i:7r v`..nd fv,•n er ~OGPIit /Ci of IJ, r D /'UCf~. <br /> <br /> <br />STATE OF COLORADO Notary Public <br />1AyCamnla~bnE~irpOB11520W My Commission expires: ~~ 1 ~lU~ <br />SIQa-T4A=S HQST BE IN SL9E INR <br />04!75/97 282: FCO.110 <br />