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- 7 - <br />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 terms and conditions: <br />1. All necessary approvals from local government have been applied for (Section 34- 32.5- 110(1)(a)(VIII). <br />2. To the best of my knowledge, all significant, valuable and permanent man -made structure(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- 115(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 /exploration operations- in theeState - oftoiora'd�urrenttyin vio a ion o <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. I 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 1 misdemeanor pursuant to Section 18 -8 -503, C.R.S. 1984. <br />This form has been approved by the Mined Land Reclamation Board pursuant to section 34- 32.5- 110,C.RS., of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials. Any alteration or modification of this form shall result in voiding any <br />permit issued on the altered or modified form and subject the operator to cease and desist orders and civil penalties for operating <br />without a permit pursuant to section 34- 32.5 -123, C.R.S. <br />Signed and dated this aQ day of Av.. <br />Harry Corkle Const <br />Signed: <br />Title: President <br />State of Colorado <br />County of Jackson <br />Applicant/Operator <br />The foregoing instrument was acknowledged before me this <br />, by <br />Harry Corkle <br />DEBRA L. GREENE <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />as <br />President <br />My Commission Expires 06 / / MUST BE IN BLUE INK <br />2011 <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />day of (1 Uy ►l.S l <br />AL,4 . <br />of Harry Corkle Const <br />,( Air0---- <br />Notary Public <br />My Commission expires: 1%9 31 RO ) a <br />