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)in existence 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 1 misdemeanor pursuant to Section 18-8-503, C.R.S. <br /> This form has been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-112,C.R.S., of the Colorado Land <br /> Reclamation Act for the Extraction o f Construction Materials. Any alteration or modification of this form shall result in voiding any <br /> permit issued on the altered or modifred 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 `1 li} day of ��U �'� 1 7 <br /> Summit Brick & Tile Co. If Corporation Attest(Seal) <br /> Applicant/Operator or Company Name <br /> C� ✓,t;,,+� .. <br /> Signed:� �L t +.i Signed: <br /> KATHLEEN A C EEMLC; NTH ()rl rate Secretary or 1=fquiva ent <br /> Title: Chief Ooeratina Officer NOTARY PUBLIC Town/City/County Cleric <br /> :STATE OF CC LORADO <br /> NtJTAW It', "'14443949 <br /> State of Colorado ) - <br /> ss. <br /> County of Pueblo ) <br /> lr� � <br /> The foregoing instrument was acknowledged before me this day of <br /> , by Matthew Welte as Chief Operating Officer of Summit Brick & Tile Co. <br /> r <br /> Notary Public <br /> My Commission expires: /4/1_J' <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 />