2016-07-20_REVISION - M2008082 - Laserfiche WebLink

Home Browse Search

-8- Certification: As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements of the following,terms and conditions: 1. To the best of my knowledge,all significant,valuable and permanent man-made structures)inexistence at the time this application is filed,and located within 200 feet of the proposed affected area have been identified in this application (Section 34-32.5-1 15(4)(c),C.R.S.). 2. No mining operation will be located on lands where such operations are prohibited by law (Section 34-32.5-1 15(4Xf),C.R.S.. 3. As the applicant/operator,I do not have any extract I on/exp lorati on operations in the State ofColorado currently in violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Met.•rial (Section 34-32.5-120,C.R.S.)as determined through a Board finding:. 4. 1 understand that statements in the application are bein,made under penalty of per ury and that false statements made herein are punishable as a Class I misdemeanor pursuant to Section 18-8-503.C.R.S. This form has been approved by the Mined Land Reclamation Board pursuant to section 34 32.5-I12,C.R.S.,of the Colorado Land Reclamation Act for the Extraction of Construction Materials. Any alteration or modijleation of this form shall result in voiding any permit Issued on the uttered or modified form and subject the operator to cease and desist orders and civil penalties fur operating without a permit pursuant tosection 34-32-5-123,C.&& `,��rrrnrrn�ryr Signed and dated this day of � -`, O O N CR G �} • GkgkPOR.4pF ..[�: SEAL =o: FNc 1�t C- �' , 1fCorporation Attest{SeaD : Apph cant/CfperatororCornpany Name 01 Si Signed: Corporate Secretary or Equivalent Title: 41 {'� Town/City/County Clerk State of County of Ent ) } The foregoing tiristrument was acknowledged before me this_ _day of V l 01 I l by ,M , Z l Z$PAr%S� i as of r'�tl�.�I k - ! LAURA K ELDREDGE NOTARY PUBLIC-STATE OF COLORA Notary Public Notary Identification#20154035976 , My Commission Expires 9/10/2014 -------•--i My Commission expires: SIGNATURES MUST BE IN BLUE INK You must post sufficient Noticcr at the location of the proposed mine site to clearly identify the site as the location of a