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• -5- • <br />Certification: <br />Ae an authorized representative of the applicant, I hereby certify that the operation <br />described has met the minimum requirements of the folloring terms and conditions: <br />1. This mining operation will not adversely s£fect the stability of any significant, <br />valuable and permanent man-made structure(s) located rithin two hundred (200) feet of <br />the affected lands. (However, where there ie an agreement betreen the <br />applicant/operator and the persona having as interest in the structure that damage to <br />the structure is to be compensated for by the applicant/operator (Section <br />834-32-115(4)(d), C.R.S. 1984, as amended), then mining may occur rithia 200 feet. <br />Proof of an agreement must be submitted to the Office prior to the decision date.) <br />2. No mining operation will be located on lands There such operations are prohibited <br />by lar (Section 34-32-115(4)(f), C.R.S. 1984, as amended); <br />3. As the applicant/operator, I do not have any mining/prospecting operations is <br />this state of Colorado currently in violation of the provisions of the Mined Land <br />Reclamation Act (Section 34-32-120, C.R.S. 198x, ae amended) as determined through a <br />Hoard finding. <br />4. I understand that statements in the application are being made under penalty of <br />perjury and that false statements made herein are punishable as a Class 1 misdemeanor <br />pursuant to Section 18-B-503, C.R.S 1984, ae amended. <br />Signed and dated this _~ day of ~- ~~~. <br />--Jc:11c~ ~ - - ` - ~ - <br />~~Ap////pli~(c~~//7ant/Oper/a~tor If Corporation Attest (Sal) _ <br />Signed: s)c/.G,~ 1~..----~--- Signed• ~ ~~14`~'~~1`~\,~~, <br />Title: `~ ~2/~~ <'~'~ ~~~~_ <br />State of l /~ ) <br />es <br />County o ) <br />Co orate Sec ta~^y or Hquicxlerit <br />Torn/City/County Clerk <br />The foregoing in~sytr~ment vas acknorledged before me this ,~~ day coif _,,~Q~, <br />by ~1~khd ( -hnn i ~ ae ~/ir.~.,(~in~ of l `.+nn i 01' ~~~ ~~ C¢d <br />Q //L.tQ~~ ~~L- m <br />Notary Public /~ <br />My Coa®iseinn expires: ~ ~- 9,~ <br />2823P.vpf <br />(0727/94) <br /> <br />