Laserfiche WebLink
-~- <br />CertiScation: <br />As an authorized representative of the applicant. I hereby czrtifY that the operation descaibed has met the minitttrun <br />requirements of the following terms and conditions: <br />1. To the best of my laiowledge, 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.RS.}. <br />2. No mining operation will be located on lands where such operations are prohibited by law (Se~ion <br />=A-32 S-Ili(4){fj; C.R.S.; <br />3. As the applicantloperator, 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 (Section <br />34-32.5-120, CRS.) as determined through a Board finding. <br />4. I understand that statelttents in the application are being made under penalty of perjtuy and that false statements <br />made herein are punishable as a Class I misdemeanor pursuant to Secion I5-8-503, C.RS. <br />Signed anddatedthis / J~ -' day of 4u~arr< 2aoZ <br />Maverick Sand & Gravel <br />ApplicantJOperator or Company Name <br />Signed: ism f . <br />ames E. Stover <br />Title: <br />Agent <br />State of _ L.,o~oc'a~~ 1 <br />ss <br />County of (BPS cLr ) <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Seccetary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this /,5 ~~ day of ~~t vs~ , <br />by ./an-rCS E S~ver2, aS ~96n~ of ~sl/E11,~t~C .SFI,JD S/ ~tYW4E'C. <br />~' <br />TM <br />` <br />/ ~ - <br />1 <br />?` <br /> <br /> <br /> <br /> <br />^,~ <br />`~~• <br />= '-~ ° 7a ~ o G <br />~ <br />~~- -~, My Conwtission expires: <br />SIGNATURES MUST BE IN BLUE INK <br />M:~~~~~rco~now~ nxa~ paiinmrt <br />