PERMFILE46718

• Permit No: M2004067
• IBM Index Class Name: Permit File
• Doc Date: 11/21/2005
• Doc Name: Exhibits 82
• From: City of Black Hawk
• To: DMG
• Media Type: D
• Archive: No

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Certification:
As an authorized representative of the applicant, I hereby certify that the operation described has met the minimtun
requiremems of the following terms and conditions:
]. To the best ofmy knowledge, all significant, valuable and permanehtman-made structure(s) in existence at the tune
this application is filed, and located within 200 feet of[he proposed affected area have been identified in this eppGcation
(Section 3432.5-115(4)(e), C.R.S.).
2. No mining opemtion will be located on lands where such operations are prohibited by law
(Section 3432.5-1IS(4xf), C R.S.;
3. As the apphcanVoperator, I do not have any exnactioo/explorationoperations in the Swte ofColorado curtrntly in
violation of the psovtsions of the Colorado Land Reclamation Act for the Extractioa of Construction Materials
(Section 3432.5-I20, C.R.S.) as determinedduough a Board finding.
4. i understand that statements in the application are being made under penalty of perjury and that false statemrnts
made herein are punishable as a Class I misdemeanor ptusuant to Section 18-8-503, C.R.S.
7AG jorm has iieen approved fry the Mined Land ReelamaBon Board parsaantlo ration 34.3Z.S-flI,GR S, ojtire Colorado Laid
Reclamation Acr jot the F.xtradion ojConstraalon Maurlafr. Aqy aherpdan or rnodiJkation ojthv jorm rhaL ruaUin voiding any
pennL tsaaed on the altcrsd or modlfred jorm and sabJec9 the operator ro cease and desist orders and elril penahies jot operating
wJthoat a permit pursuant to section 34.3YI23, CRS
Signed and dated this ~ day of do % d~ - '~o~f- .
Clear Creek Dtstri Water Providers, LLC T
Appjcanf(t7pemtor or tp ty N
Signed Sighed: i/~fi
C
Tide. ~~~ Town/CitylCotmty Clerk
Smteof~~~81`OIJ~I )
ss.
County of Gt DQ hQ~_ )
The fo~,e,gg~ing instrument was aclmowledged before me this ~ day of l7ULI"
-, by 7~nFxr"i` !4. G,tinbe~c- aa~dR~r./ of!'I!~//t/l~lC.,diSt/r¢~1~~~~1~~J
:~ Q, ~~`e _^~A~ Lei
No~,~-tary4~P,u~},bl^ic[n yJ'1
My Commission expires' ~ ~ S
SIGNATURES MUST BE IN BLUE [NK