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 Lard Redamiadon Board pursuant to section 34-32.5-112,GRS.,of the Colorado Land <br /> Reclamation Act for the F-tnacdon of Construction Materials. Any alteration or modfficadon of this form shall result in voiding any <br /> permit issued on t#re altered or modified form and subject t#e operator to cease and desist orders and civil penalties for operating <br /> without a permit pursuant to section34-32.3-1239 GRS <br /> Signed and dated this! day of a© ' <br /> T <br /> 4y-ol� L LC If Corporation Attest(Seal) <br /> Appl 6nt/Operator or pany Name <br /> Signed: Signed: <br /> Corporate Secretary or Equivalent <br /> Title: Owner Town/City/County Clerk <br /> State of C ) <br /> )ss. <br /> County of <br /> The foregoing instrument was acknowledged before me this day of <br /> by Cn 3CP-'C3 as of <br /> ;y?`•'"VP``%•; MELLISA BLACK <br /> *; *, MY COMMISSION#GG 274213 Notary Public <br /> +, oP EXPIRES:March 5.2023 <br /> FosF� <br /> Bowled <br /> ,,,ti► ,, 5 ao 1102 <br /> My Commission expires: <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 /> s <br />