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)(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 /> Thu form has been approved by the Mined Land Reclamation Board pursuant to section 34 32.5-1IZC.R.S.,of the Colorado Land <br /> Reclamation Actfor the Extraction of Construction Materials. Any alteration or modification of this form shall result in voiding any <br /> permit issued on the altered or modifted 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.&S <br /> on <br /> Signed and dated this 1 day ofag' <br /> r A If Corporation Attest(Seal) <br /> Applicant/Operator or Company Name <br /> r <br /> Signed: Signed: <br /> k <br /> Corporate Secretary or Equivalent <br /> Title: C3 ,`�-j/L,QS�r Town/CityfCounty Clerk <br /> State of „�c� <br /> County of 112--aLm e )s <br /> The foregoing instrument was acknowledged before me this day of , <br /> DZ.J L,by as .t`�t) Z <br /> L <br /> t7 <br /> I Q �7__Z C'aRf <br /> DEWEY C CHANDLER Notary Public <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20034040354 My Commission expires:_!�/ ze , <br /> W COMMISSION EXPIRES JUNE 22,2020 <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 />