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-6- <br />ertification: <br />s an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requireanents of <br />-e following terrnns and conditions: <br />All necessary approvals from local govearnment have been applied for (Section 34-32.5-110(lxa)(VIII). <br />2. To the best of my knowledge, all significant, valuable and permanent man-made stnlcture(s) m existence at the time this <br />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(4xe), C.RS.). (NOTE: For 110 operations, the affected area includes all lands delineated by the <br />permit boundary.) <br />3. 13o mining operation will be located on lams where such operations are prohibited bylaw (Section 34-32.5-115(4)(f), <br />C.RS.). <br />4. As the applicant/operator, I do not have any mining/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 <br />(Section 34-32.5-120, C.RS.). <br />5. I understand that statements in the application are being made under penalty of perjury and that false statements made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. 1984. <br />this form has been approved by the Mined Land Reclamation Board pursuant to se~ion 3¢325-I1 D,GRS, ojthe Colorado <br />:and Reclamwtion Ad for the Extracxion ojConstrucxion Materials. Any alteration or nwdifuxrtion of this form shall result <br />n voiding any permit issued on the altered or modified form and subject the operator to cease and desist orders and civil <br />penalties jar operating without a permit pursuant to section 3~h32--123, GRS <br />3ignedanddatedthis First day of November 2007 <br />Lincoln County , Colorado If Corporation Attest (Seal) <br />Applicant/Operator <br />Signed: i~.....,.'~ <br />Title:Land Use Administrator <br />Signed: <br />State of ~1~0 1 <br />ss. <br />County of l~ ~~\ r. <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instnunent was aclmowledged before me this l~ day of IJ ~ w.1~ 7.a-o"I- . <br />by _~ .~-~-.~s~ ~ 1.~.v.~.u~ Aa,.~,.~ r~s~~ of l...i~.~l~. ~.,.~--~ <br />Notary Public <br />My Commission expires: ~-Q~' - ~y . 2 tr° 5 <br />SIGNATURES MUST BE IN BLUE INK. <br />M:koin~ahare\vsfom~e~Ccostruction110 (0788/2004) <br />