Laserfiche WebLink
RECEIVED RECEIVED <br /> UCT 0 5 2022 _ s _ OCT 0 5 2022 <br /> Certification: OF RECMAT10N WELD CO <br /> owisioN p sin COMMISSIO S <br /> MINING� <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. 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 operating <br /> without a permit pursuant to section 34-32.5-123, C.^^R.S. <br /> Signed and dated this _day of t_i oIY <br /> <3(wek\ L.G \u 1'6�,N�C�j� L�Cs If Corporation Attest(Seal) <br /> Applicant/Operator or Company Name <br /> k�`, �L-c\ 012 <br /> Signed: Signed: <br /> p Corporate Secretary or Equivalent <br /> Title: \c�n� Town/City/County Clerk <br /> State of C b y( Q a l"..> ) <br /> 1 )ss. <br /> County of l/V C�a __ ) <br /> The f going instrument was acknowledged before me this day of C-VW­r_ , <br /> Z ,by I L Q 5tyn U 5 u as of V—OYW-e- t LQ r o - \6►n� <br /> PAOLA BUJANDA Notary Public <br /> NOTARY PUBLIC <br /> STATE OF COLORADO �n <br /> NOTARY ID 20224009614 My Commission expires: I" CA,-U, Gl, Zb Zip <br /> MY COMMISSION EXPIRES MARCH 9, 2026 <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 />