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) 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 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 I 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.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 Z4-'!3 <br />day, of <br />oZD ` <br />C 1 1. J 64 LA <br />Applican per for or Co pany Nam <br />Signed: <br />Title: J J ;W\ m C15 0. <br />State of Lk._n-T0.4 <br />ss. <br />County of —bo" k A'cT <br />If Corporation Attest (Seal) <br />Corporate Secretary or Equivalent <br />Town/C/County Clerk <br />The foregoing instrument was acknowledged before me this day of <br />pi0l. by r It 1 as CA-, Ptvl --111530 r _ of t Lc c t1c. eco <br />V IT <br />oo ARS <br />G.Q <br />You must p 3 Rkali ;Fx <br />Notary Public <br />My Commission expires: 11-2 i ami <br />SIGNATURES MUST BE IN BLUE INK <br />at the location of the proposed mine site to clearly identify the site as the location of a