Laserfiche WebLink
-7- <br />Certification: <br />As an authorized representative of the applicant, I hereby edify that the operation described has rst the minimum requirements of the <br />following terms and conditions: <br />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 the State of Colorado currently in violation fi <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 nade under penalty of perjury and that false statemnts 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.R.S., of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials. Ap alteration or modification of this form shall result in voiing 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- 325 -123, C.R.S. <br />Signed and dated this �� day of )� lAal PL—>+ , J c� NT �aG,y y1 <br />;1 k( A \L Y <br />i1, r Vii 1 1.5ell ortOrs If Corporation Attest (Seal' <br />Applicant/Operator T T <br />C�, ....• <br />Signed: <br />Title: Cila I r V Y)CLn <br />Signed <br />Corpor e Secretary or Equivalent <br />1 s�State of ) <br />ss. <br />County of ) <br />The foregoing ) <br />oorregoing instrument was acknowledged before me this `� day <br />, by 1 t E f. )C _ J 1. as D'o Un 1 <br />Town/City /County Clerk <br />V�oz `66 '100 S3MldX3 <br />NOISSIWW <br />0 <br />8 V V8ZV ON S O0d2O1OO dO 31d1 otary Pub is <br />O18fd A2tlON <br />y Commission expires: <br />V031HO 3113NIN`d <br />SIGNATURES MUST BE IN BLUE INK <br />/b/11 <br />13 <br />