Laserfiche WebLink
-, <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the nilnimum requirements <br />of the following terms and conditions: <br />~. <br />1. To the best of my lmowledge, all significant, valuable and permanent man-made structure(s) in existence at the time this <br />application is fled, 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 (Section 3432.5-1 IS(4)(t), <br />C.R.S.; <br />3. As the applicant/operator, [ 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 (Section <br />34-32.5-120, C.R.S.) as determined through a Board finding. <br />4. I understand that statem~vts in the application are being made under penalty of perjury and that false statements made <br />herein aze punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. <br />`~~ So~S` , h~z`tl°i <br />Signed and dates this ~f~- day of , ~~. <br />Apph~Operator or Company Name <br />Signed: I~~""" "- Signed: <br />Title: L~ ~ . C~ a rv~t.~.1C~. , <br />State of Colorado <br />) SS <br />County of Otero 1 <br />If Corporation Attest (Seal) <br />Corporate Secretary or Equivalent <br />Towo/City/County Clerl: <br />The foregoing instntment was aclmowledged before me this 23rd day of January 2001 <br />byPe¢zv Proctor Frantz as Member of Roush Cut. LLC <br />QM ~ <br />Notary Pub c <br />,~ <br />My Commission expires: <br />SIGNATURES MUST BE IN BLUE INK <br />12-30-01 <br />