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(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 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 34-32.5-110,0 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. rr�� <br />Signed and dated this ✓' f' ' " day of / 1/2'1 GAG // \ <br />Z-11(4 !"I u q i^ r 1/ If Corporation Attest (Seal) <br />Applicant/Operator / <br />„c" ^� <br />Signed: <br />Title: rcr x <br />State of WtcL,— ...k --,t c=>) <br />) ss. <br />County of C_A.S. -ter" ) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this t teh day of M G rr�- t aO 1 Le, , <br />, by E.c 1 Lt c t--1,5 as l�r-,e. Si r -_-1 -e....-- 4- of L. U C.IL,e \I—J.: Qu a,►ti2.3 <br />KELLEYy Ell <br />wearNoe <br />Stair oI Condo <br />Nota <br />My Commission expires: tea.tp <br />SIGNATURES MUST BE IN BLUE INK <br />