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Certification. <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements of the <br />following terns and conditions: <br />All necessary approvals from local government have been applied for (Section 34-32.5-1 100)(a)(VIII). <br />2. To the best of my knowledge, all significant, valuable and permanent man-made stntcture(s) in 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 34-32.5-1 15(4)(e), C.R.S.). (NOTE: for 110 operations, the affected area includes all lands delineated by the permit <br />boundary.) <br />3. No mining operation will be located on lands where such operations are prohibited by law (Section 34-32.5-115(4)(f), <br />C.R.S.). <br />4. As the applicant/operator, I do not have any mining/exp[oration operations in the State of Colorado currently in violation of' <br />the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-120, C.R.S. ). <br />5. 1 understand that statements in the application are being made under penalty of perjury and that false statements made herein <br />are punishable as a Class l misdemeanor pursuant to Section 15-8-503, C.R.S. 1934. <br />This form has been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-110X. R.S., of the Colorado Land <br />Reclamation Act for the Grtraction of Construction Materials. Ann alteration or modification of this form shall result in voiding <br />any permit issued on the altered or modified fora: and subject the operator to cease and desist orders and civil penalties for <br />operating without a permit pursuant to section 34-32.5-123, C.R.S. <br />?^ <br />Sign f dated this . XC_--day of a c ?di_?_• <br />-2L if Corporation Attest (Seal) <br />ApplicanCOperator <br />Signed: 110 1 rt' a_ °r Signed: <br />Corporate Secretary or Equivalent <br />Title: ___0 1,-) klC [- To%vn/City. County Clerk <br />State of <br />} ) ss. <br />County <br />5--__--f <br />The foregoing instrument was acknowledged betbre me ttws day of - - <br />1.??-tYS[?r. <br />by -1--emu C.__ of <br />4N,ota?blic <br />My Commission expires: -.ZL,0 <br />ICN \ I t RES NtUM BPI' IN BLUE INK <br />s I