Laserfiche WebLink
i <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)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 34-32.5-1 15(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 Alined Land Reclamation Board pursuant to section 34-32.5-112,C.R.S.,of the Colorado Land <br /> Rechunation Act for the Extraction of Construction Materials. Anr alteration or modification of this form shall result in voiding air <br /> n <br /> perinit issued o the altered or modifned 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. J RU CK! <br /> Signed and dated this 10th day of April <br /> Kelley Trucking Inc If Corp anti C�fc,�t��� TE <br /> Applicant/Operator or Company Name L <br /> Signed: A Si-ne . <br /> Corporat ecretary or Equivat <br /> Title:( / j'lQ�iVT Town/City/County Clerk <br /> State of Colorado ) <br /> ss. <br /> County of Jefferson ) <br /> The foregoing instrum n was acknowledged before me this APE <br /> day of April _ 2020 <br /> by I �y as Vim APt of Kelley Trucking Inc. <br /> FN80TARY <br /> OXANNA D.SPRENGER Note ry Public <br /> No <br /> PUBLtC <br /> TATE I C0190 O OS <br /> ID 20194017508 /V <br /> WMWUMN�PRES 05t1512043 My Commission expires: <br /> SIGNATURES MUST BE IN BLUE INK <br />