Laserfiche WebLink
- 7- <br /> Certification: <br /> As an authorized representative of the applicant,I hereby certify that the operation described has met the minimum requirements of the <br /> follow ing terms and conditions <br /> 1. All necessary approvals from local government have been applied for(Section 34-32.5-110(l)(a)(VIII) <br /> 2 To the best of my knowledge,all significant,valuable and permanent man-made structurc(s)in existence at the time this <br /> application is filed, and located within 200 feet of tlac proposed affected area have been identified in this application <br /> (Section 34-32 5-115(4)(e),C.R.S.) (NOTE: For 110 operations,lice affected area includes all lands delineated by the permit <br /> bouuxharn ) <br /> No mining operation will be located on lands where such operations arc prohibited by labs(Section 34-32.5-115(4)(f), <br /> C R.S.) <br /> 4 As the applicant/operator,I do not have any mininglcxploration operations in the State of Colorado currently in violation of <br /> the pro%usions of the Colorado Land Reclamation Act for the Extraction of Construction Materials(Section 34-32.5-120,C R S) <br /> 5 1 understand that statements in the application arc being made underpcnalty of perjury and that false statements made herein <br /> arc punistulblc as a Class 1 misdemeanor pursuant to Section 18-8-503,C.R.S. 1984. <br /> 7H%form has been approved bv the Mined Land Reclamation Board pursuant to section 34-315-110,C.R.S.,ofthe Colorado Land <br /> Reclamation Ad for the Extraction of Construction Materials.Any alteration or mod fc dion of thisform shall result in voiding any <br /> permit issued on the altered or mod fuel form and subject the operator to cease and desist orders and civil penalties fair operating <br /> nilhout a permit pursuant to�seetion 34-32.5-123,C.R.S. <br /> Sugnod and dated this / day of October 2021 <br /> Tara Sanders If Corporation Attest(Seal) <br /> Apph' anUOperator <br /> i <br /> Signed: Signed: <br /> Corporate Secretary or Equivalent <br /> Title Applicant/Operator TownlCitvlCounty Clerk: <br /> State of Colorado ) <br /> ss <br /> Count} ofc. ) <br /> The foregoing instrument was acknowledged before me this � L day of October, 2021 <br /> .b� Tara Sanders as Applicant/Operator of <br /> IC: <ry Public <br /> NIN Commission expires- f U y <br /> SIGNATURES MUST BE IN BLUE INK <br /> gr <br /> P <br /> t <br /> I <br />