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 Board pursuant to section 34-32.5-112,CR.S.,of the C*irmlia jand <br /> Reclamation Act for the Extraction of Construction Materials Any alteration or modification of thisform shall ra; n fy <br /> permit issued on the altered or modified form and subject the operator to cease and desist orders and civil peo(�1a <br /> without a permit pursuant to section 34-32.5-123,C.R.S. :�V Aq �C-) <br /> Signed and dated SEAL <br /> this day of - - <br /> tk c 5C 6A* = G . If Corporation Attest(Sea14 IG P� <br /> Applicant/Operator or Company Name <br /> Signe 1100 Signed:-- <br /> Corporate Secretary or Equivalent <br /> Title: V C `r � '- Town/City/County Clerk <br /> Stateof (NoViO ) <br /> ss. <br /> County of_ ) nq <br /> The foregoing trument was acknowledged before me this_ ( $ day of a r; <br /> 2 LZ 2 by bin v �1��'�s� as U �� Q1't�i d t'�-+F— of XL= Se'et -to, C . <br /> =20104ol5234 <br /> NO <br /> C Notary Public <br /> NOTqyY ID <br /> DO n� �y <br /> $2024 My Commission expires: {Y 10,0 <br /> J 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 />