Laserfiche WebLink
-~- <br />Certification: <br />As an authorized representative of the applicant, I hereby ecrrify that the operation described has met the minimum requirements of the <br />following terms and conditions: <br />All necessary approvals from local govemmen[ have been applied for (Section 34-32.5-I 10(1)(a)(VIII). <br />2. To the best of my knowledge, all significant, valuable and petrnanent mat[-made structure(s) in existence at the time this <br />application is filed, and located within 200 feet of fhe proposed affected area have been idenrified in [his application <br />(Section 34-32.5-115(4)(e), C.R.SJ. (NOTE: Por 110 operations, the affected area includes all lands delineated by the permit <br />boundary) <br />3. No mining operation wilt be located on lands where such operations an: prohibited by law (Section 34-32.5-115(4)(f), <br />C.R.S.). <br />4. As the applicanUoperator, I do not have any mining/exploration operations in the State of Colorado currently in violation of <br />the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-120, C.RS.). <br />5. 1 undersffind that statements m [he application are being made under penalty ofperjury and that false statements made herein <br />are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. 1984. <br />Thlsform has been approved by theMined Land Reclamation Baard pursuant to section 34-31.5-//D,C.RS, ofthe Colorado Land <br />Rec/ar»ation Act jor the Extraction ojCons[raction Mmerials. Arty akeratfon or modijfcation ojth/s jorm shall resin! in voiding <br />any permf! issued on the altered or modified jorm and subject the operalor to cease and desist orders and civil penahies for <br />operating without a permit pursuant to section 34-31.5-/13, C RS. <br />Signed and dated this ~/o ~ day of `~i3-i[-/irn.~N/1 .2FJ!% 6 <br />Ritcheys' Redi-Mix Concrete, Inc. <br />ApplicanUOperator <br />Signed: 2[~.r „__.w FrC~_ yi.a..i- <br />Title: (hun er // <br />If Corporation Attest (Seal) <br />, i <br />Sign <br />C tporate Secreffiry or Equivalent <br />Town/City/County Clerk <br />State of Colorado <br />ss. <br />County of Phillips _) <br />The foregoing instrumeni was ackttowledged before me this -.2 ~ ~t day of __-~~11;~v~~L%lJ 2. B~ ~ , <br />-~bY Sers~-Ritchey as Owner/Ooerator of <br />Ritcheys' Redi-Mix Concrete, Inc. <br />Notary Public <br />My Cormnission expires: 2-22--08 ~ / _ <br />SIGNATURES MUST' BE IN BLUE INK <br />M~lmin`share\vsGtmu`,ConsW clime 110 (ApprnvcA OS/I 12W5) <br />