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Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has nlet the I inlinltllll <br />requirements of the following terms and conditions: <br />i . To the best of my knowledge. all significant. valuable and permanent man-made structure(s) in existence at the time <br />this 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)(c). C.R.S.). <br />3. No mining operation will be located on lands where such operations are prohibited by la\\ <br />(Section 34-32.5-115(4)(f). C'.R.S.: <br />3. As the applicant/operator. 1 do not have any extraction'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.R.S.) as determined through a Board finding. <br />4. 1 understand that statements in the application are being made under penalty of perjury and that false statements <br />made herein are punishable as a Class I misdemeanor pursuant to Section 18-8-503. C.R.S. <br />This form has been approved hr the alined Land Reclamation Board pursuant to section 34-3 2.5-112,GR.S., of the Colorado Land <br />Reclamation. 4et far the Extraction of ('onctrac•tion .llaterials. . tnY alteration or modilication of this /arm shall rewclt in voidinr,: an). <br />permit issued on the altered or tuodilied form and suhjec•t the operator to cease and desisl orders and civil penaltic•.c.for ope•rati , <br />without u permit pursuant to section 34-32.5-123, C.K.S. <br />Signed and dated this ---` day of <br />Grand County Department of Road and Bridge <br />Applicant. Operator or Company N• me <br />Signed: C?L F. -ZQVS <br /> <br />If Corporation ,Attest t Seal ) <br />Signed: _4 f -- <br />orpuratc c« : q?lv,i cl <br />I itle: Road Superintendent <br />State of Cnlora,-An ) <br />ss. <br />County of Gir CLe a ) <br />Town CitviCounty Clerk <br />The foregoing instrument was acknowledged before me this Z $ ` day of Stu 1u <br />2 a7 by Al -ti F_ . 1 .yfj L S as ' vmx d S ?tr'? c.•v?t.?1- of (g rand Cv ? n?F Tt_?C?n ??mtn t <br />of 1? oa_o1 and I`Jr ; dgL . ., . , ? <br />•' Notary Public <br />My Commission expires: V J3?4\ <br />SIGNA'ATRIJES 11UST BY, IN BLUE: INK <br />YOU must post sufficient Noticcs at the location of the proposed mine site to clearly identify the site as the location of a