Laserfiche WebLink
-8- <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum <br />requirements of the following terms and conditions: <br />1. 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- 115(4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by law <br />(Section 34- 32.5- 115(4)(f), C.R.S.; <br />3. As the applicant/operator, I do not have any exttaction/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 1 misdemeanor pursuant to Section 18 -8 -503, C.R.S. <br />This form has been approved by the Mined Land Reclamation Board pursuant to section 3¢32.5- 112,CRS, 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, CRS. <br />Signed and dated this day of <br />Richard F. W ay tt/Wyatt Redi- If Corporation Attest (Seal) <br />Mix Co. <br />Applicant/Operator or Company Name <br />Signed: Signed: <br />Corporate Secretary or Equivalent <br />Title: President Town/City /County Clerk <br />State of Colorado ) <br />) ss. <br />County of Jackson <br />The foregoing instrument was acknowledged before me this day of <br />, by as of <br />Notary Public <br />My Commission expires: <br />SIGNATURES MUST BE IN BLUE INK <br />