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)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(4xf),C.R.S.; <br /> 3. As the appl icant/opemtor,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 Board pursuant to section 34-325-112,C)L&,of the Colorado Land <br /> Reclamation Act for the Extraction of Construction Materials. Any alteration or nwdifleadon of this form shall result in voiding any <br /> permit issued on the altered or m od1fled 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 gT day of 20 <br /> J f14k /CaW 4 p �QyicN 1. ( , If Corporation Attest(Seal) <br /> Appliedit/Opemtor or Company Name <br /> Signed: = r — Signed: <br /> Corporate Secretary or Equivalent <br /> Title: 4f 0Nk pe r Town/City/County Clerk <br /> State of CQ fDYci 4 <br /> )ss. <br /> County of D�n\f r <br /> The foregoing instrument was acknowledged before me this 4 day of Hb !� 4 <br /> 4QI , by R Uay\ -Jr. as M(A aagtr of )r n&4 PAWL 4111610 LW <br /> E <br /> RA SONGARY PUBLIC Notary Public <br /> OF COLORADO 10 20174042279XPIRESOCTOBER11.2021 My Commission expires: 10/11/ 2L l <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 />