Laserfiche WebLink
-8- <br />Certification: <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) inexistence 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)(1), C.R.S.; <br />3. As the applicant/operator, I 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. I 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 34- 32.5- 112,C.R.S., 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 3O day of <br />S If Corporation Attest (Seal) <br />Applicant/0 era or Com any Name <br />Signed- Signed: <br />Corporate SecretarPor Equivalent <br />Title: County Commissioner <br />Town/City /County Clerk <br />State of ed /DY a c✓O ) <br />) ss. <br />County of 11'41 111<f0 S <br />) <br />The foregoing instrument was acknowledged before me this day of &2r 1 , <br />by as 6t112 4V of ' _Ph111 <</'? 7z1 <br />RANDALL D. SCHAFER <br />NOTARY PUBLIC <br />STATE OF COLORADO Notary Public <br />NOTARY ID 19954016062 <br />MY COMMISSION EXPIRES 12/06/2016 My Commission expires: <br />SIGNATURES MUST BE IN BLUE INK <br />You must post sufficient Notices at the location of the proposed mine site to clearly identify the site as the location of a <br />