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. 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 Mined Land Reclamation 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 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 penalties for operating <br /> without a permit pursuant to section 34-32.5-123, C.R.S. <br /> Signed and dated this 2 IS-' day of <br /> (bn'7 � (,� � �h�i If Corporation Attest(Seal) <br /> Applicant/Operator or Company Name <br /> Signed: Signed: <br /> Jr <br /> Corporate Secretary or Equivalent <br /> Title: //Cf•.91 . Town/City/County Clerk <br /> State of Cp o `QA(= ) <br /> ��.J b ) <br /> County of ss.) <br /> The foregoing instrument as acknowledged before me this day of <br /> IN <br /> WI R, by_, f� .SS a.r� as of � `tan I1C, <br /> 12 <br /> DEBORAH A. <br /> i NOTARY PU!tL.:C Notary Public <br /> STATE OF COLD.!V00 1 1 1L !\ <br /> NOTARY ID 20':�/4000024 My Commission expires: L" ' '�02V <br /> IMY COMMISSION EXPIF_; �'VUr".RY 4,2020 <br /> J�(� SIGNATURES MUST BE IN BLUE INK <br /> D B��� � TntINdtic at the location of the proposed mine site to clearly identify the site as the location of a <br /> STATE OF COLORADO <br /> NOTARY ID 20164000024 <br /> MYCOMMISSION'EXPIRES JANUARY 4,2020 <br />