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 t a <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. <br /> Reclamation Act for the Extraction of Construction Materials. Any alteration or modification of this fors <br /> permit issued on the altered or modifred form and subject the operator to cease and desist orders and. <br /> without a permit pursuant to section 34-32.5-123, C.R.S. <br /> Signed and dated this d day of , <br /> Z� <br /> L.G. Everist, Incorporated If Corporation Attest(Seal) <br /> Applicant/Operator or Com e <br /> Signed: Signed: &OL l <br /> Corporate e retary or quivalent <br /> Title: President Town/City/County Clerk <br /> State of SDA h Di�—,ur� ) <br /> s <br /> County of I � 1 \In I(�.��) ) <br /> The foregoing instrument was acknowledged before me this day of <br /> a�a�Jby Robert E. Everist as President of L.G. Everist, Incorporated <br /> CARRIE A. GARRY <br /> Q.-� NOTARY PUBLIC <br /> SI <br /> �`` SOUTH DAKOTA Notary Public <br /> My Commission Expires a5 My Commission expires: -7 ` <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 />