Laserfiche WebLink
- 8 - <br />Certification: <br />As an authorized representative of the applicant, 1 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. 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 Inas been approved by die Mined Land Reclamation Board pursuant to section 34-31.5-111,0 R.S., of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials. Any alteration or modification of this form 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 perralties for operating <br />without a permit pursuant to section 34-31.5-113, C.R.S. <br />Signed and dated this „ %, r% day of <br />r <br />Applicant/Operator or Company Name <br />Signed,� <br />If Corporation Attest (Seal) <br />Signed <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of sg. 1 <br />ss. <br />County of (41ki,1✓ <br />The lbregointi nitrument ff�� s acknowledged before me this f"+ day of /.4' /# f <br />. b\ - --- i�i.��.I� L-' F.ri,,h: as 4 ): i ilw ; ! of l+ <br />ICAC, M; KFEYS �- <br />srzT Cr- co:.CRAPO Notary Public <br />NO 1ARY'D 19914004823 <br />AFl L{31AIM'N EXRRt S 04 -!?3.,1'9 <br />My Commission expires: {=: <br />SIGNATURES MUST BE IN BLUE INK <br />vn„6 mv��mmi nineertnost sPTici t Notices at the locatiggl9f14�gQos }t to clearly identify the site as the locgtion of <br />719-589-6147 <br />Alamosa, CO <br />