Laserfiche WebLink
ME <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 34-32.5-115(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. 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 Mined Land Reclamation Board pursuant 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 open n <br />without a permit pursuant to section 34-32.5-12$ C.R.S. {p I� <br />AN'�"a A"�nt <br />Signed and dated this,_ day of Sy"E— <br />7 t oww y' <br />Applicant/ for or Company Name <br />Si �� '' <br />Title:ReC(.wj—/47G1, vtlf,'A-YrW C V0r1'APty_ <br />.-ZOZ. <br />SEAL <br />If Corporation Attest (Seal) <br />Signed: N q \IV\� f\) 1 `A <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of Cc'\O('G <) ) <br />ss. <br />County ofUU'IY\\ ) <br />The foregoing instrument /was acknowledged before me this day of �C LI12 F <br />aGl,\\,by� )K1as tclQ oft,DDC. COnYI�I�� <br />NANCY L WRIG <br />NOTARY PUBLIC Mk 1YVA4 <br />STATE OF COLORADO Notary Public <br />NOTARY ID 199MI9442 <br />WCOIMM MEXPIMSAM1.2022 <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 />