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APPENDIX B <br />APPLICANT CERTIFICATION REGARDING NOTICE TO MINERAL ESTATE OWNER <br />/70 <br />a:e-submitted an application for land use approval from <br />I, <br />Park County generally described as: <br />_ A Rezoning Application <br />An Planned Unit Development <br />An Exemption from Subdivision <br />A Road Vacation <br />A Subdivision Application <br />A Common Plat Amendment <br />A Administrative Plat Amendment <br />A Conditional Use Permit <br />A Special Use Permit <br />A Variance <br />I understand that state law, found at CRS 24-65.5-101 through 24-65.5-104, <br />imposes specific legal requirements involving my providing written notice to the <br />mineral estate owner of my application. <br />I HEREBY CERTIFY that I have complied with the notice requirements imposed <br />upon me by CRS 24-65.5-101 through 24-65.5-104. <br />Signature of Applicant <br />Pring Name: 1136- IVY=_U <br />For County Use Only <br />Application Name/Case <br />Application last revised 11117/04.