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 ofthe 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)(0,C.R.S.; <br /> 3. As the applicant/operator,I do not have any extraction/exploration operations in the State ofColorado 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. 1 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 1 misdemeanor pursuant to Section 18-8-503,C.R.S. <br /> This form has been approved by the Wined Land Reclanation Boardpursuant to section 34-32.5-112,C.R.S.,of the Colorado Land <br /> Reclamation Act for the Extraction of Construction Materials. Any alteration or modification of thisform 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 01' day of <br /> 1��Itr���yy cs t%t1i /�i� �/•�l "/" +�' t l��c , If Corporation Attest(Seal) <br /> ApplicantlOperator or Company Name <br /> n j) ' <br /> Signed: �! � Signed: J <�64'1 <br /> Corporate Secretary or Equivalent <br /> Title: ok- Town/City/County Clerk <br /> State of C 1 /Nl ck c ) <br /> )ss. <br /> County of <br /> The foregoing instrument was acknowledged before me this day of <br /> y <br /> by Z Li as <br /> RANDALL D. SCHAFER <br /> NOTARY PUBLIC <br /> STATE OF COLORADO Notary Public <br /> NOTARY ID 19954016062 <br /> MY COMMISSION EXPIRES 1210612016 My Commission expires: L' <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 />