Laserfiche WebLink
-7- <br /> Certification: <br /> As an authorized representative of the applicant.I hereby certi Cy that the operation described has met the minimum requirements of the <br /> following terms and conditions: <br /> I. All necessary approvals from local government have been applied for(Section 34-32.5-110(1)(aH 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)(c).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 haveany mini n&/exploration operations in the State of Colorado currently in violation of <br /> the provisions of the Colorado Land Reclamation Act fbr the Extraction ofConstruction Materials(Section 34-32.5-120,C.R.S.). <br /> 5. 1 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. 1484. <br /> This form has been approved by the 1lfined Land Reclamation Board pursuant to section 34-3>5-110,C R.S.,of the Colorado Land <br /> Reclanwdon Actfor Me Extraction ofConstruction Materials. Any alteration or modification of thisform shall result in voiding any <br /> permit issued on the altered or modifred farm and subject the operator to cease and desist orders and civil penalties for operating <br /> without a permit pursuant to section 34-3?5-123,C.R.S. <br /> Signed and dated this �~ day of _ (2 <br /> Jo�� L�nr.ar,5 Corti►���.,.-�i �-.�,a Aet5 If Corporation Attest(Seal) <br /> A ppl icant/Operator <br /> Signed: Signed: <br /> Corporate Secretary or Equivalent <br /> Title: GM Town/City/County Clerk <br /> State of <br /> )ss. <br /> County of ) J <br /> The foregoing instrument%vas acknowledged before me this �Gt day of <br /> by as of �+*� <br /> KATHI GLANZ <br /> NOTARY PUBLIC <br /> STATE OF COLORADO Notary public <br /> NOTARY ID 20034090068 <br /> MY COMMISSION EXPIRES 031=2019 My Commission expires: -3htalf � — <br /> SIGNATURES MUST BE IN BLUE INK <br />