Laserfiche WebLink
-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(1XaXVIII). <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(4Xe), 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(4Xf), <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 of <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 34-32.5-11O,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.RS. <br />Signed and dated this 30th <br />Daniel L. Collins <br />day of December <br />Applicant/Operator <br />Signed: /� <br />Title: Managing Partner <br />State of Colorado ) <br />County of San Miguel ) ss. <br />The foregoing instrument was acknowledged before me this 1 <br />,by I k-.1\ ) ( ;-- (. 0 / L h ) <br />If Corporation Attest (Seal) <br />Signed: �j L_ L �_ <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />day of i(7( i/ <br />as ft\ ,h 1�'' )'tC \;' l/ of (?I <br />Notary Public <br />My Commission expires: O.2-/ / 4 / <br />PATRICK DASARO <br />NOTARY PUBLIC <br />STATE OP COLORADO <br />NOTARY ID 20094003856 <br />MY C0MM±SS101r EXPIRES 02/142017 <br />SIGNATURES MUST BE IN BLUE INK <br />