Laserfiche WebLink
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(Section <br /> 34-32.5-115(4)(f).C.R.S.; <br /> 3. As the applicant/operator, I do not have any extract]on/ex p lorat ion 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(Section <br /> 34-32.5-I20,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 /> Sighed and dated this 3(•d day of Win.v,�.,�L o t <br /> Goo- 5-ahms 1_.1...0 If Corporation Attest(Sea]) <br /> Applicant/Operator or ompany Name <br /> r Signed: <br /> Corporate Secretary or Equivalent <br /> Title: 1Vtc--WiW4 - Town/City/County Clerk <br /> State of Co to c-oj6o ) <br /> )ss <br /> County of_ K(Dotc:z utrt8 ) <br /> The foregoing instrument was acknowledged before me this ir 6 day of __�a nuaf' <br /> y��S Suers &,Apw pj3 LIL <br /> b 1 r� �. Go�suC.1, as�lan o�,r of rcx�; <br /> Notary Public <br /> My Commission expires: '�- 22 1.06 <br /> SIGNATURES MUST BE IN BLUE INK <br /> M.MW AREWSF0RMSU323C012.APP 0200199 <br />