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,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 /> SQ.C$ALT;F <br /> Signed and dated this �A day of oG fo 19 'je,02U,2iy � <br /> 45�lice I f Sjo�� 41f es Co.�nL. If Corporation �': (gza s�RATE g <br /> Applicant/Operator or Company Name <br /> 1992 <br /> Signed �� Signed: e7 ► •'� +; <br /> • - • <br /> Corporate ' ecr- . . ►uivalent <br /> Title: POE`S ei4 +wn/City/County Clerk <br /> State of Cp.L o uzz,,do ) <br /> )ss. <br /> County of AcktA s ) <br /> The foregoing instrument was,lacknowledged before me this day of O�_�o en,2O24,by Pc.n;GI WI He HI as Pg.e3;Gc(/e ofA-S111r_N (.2.0.1;4 . <br /> Jan Nelson <br /> NOTARY PUBLIC <br /> STATE OF COLORADO Notary Public <br /> NOTARY ID 19994030527 t j <br /> MY COMMISSION EXPIRES May 03,2028 My Commission expires: lNc+�y3 ,2G <br /> SIGNATURES MUST BE IN BLUE INK <br />