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)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 Boardpursuant 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 /> ak <br /> Signed and dated this 8 day of Al o y e m be-r 2G�2-2 <br /> QS w e_t C o., InC. If Corporat' eal) <br /> Applicant/Operator or Company Name �yQ�G�PT/ <br /> 01. <br /> Signe <br /> V� <br /> a <br /> U4"L ecret P} ,r Equivale <br /> Title: President 199 w /C' /County Clerk <br /> State of Co [ d A-ce-�d <br /> ss. <br /> County of A d a rK - ) <br /> The foregoing instrument was acknowledged before me this day of 40 V P-M b e W , <br /> a��,by �av�;a Vt/• }¢u�-F' as piles,'�e.��" of syo{ ��' �.c,�Ti�—s Cr j Y/le <br /> JAN NELSON <br /> NOTARY PUBLIC Not Public <br /> STATE OF COLORADO <br /> NOTARY ID 19994030527 <br /> My Commission Expires April 29,2024 My Commission expires: 4 y <br />