Laserfiche WebLink
-7- <br />Certification: <br />As an authorised representative of the applicant, l hereby certify that the operation described has met the mininnun requirements of the <br />followiag terms and condifions: <br />All necessary approvals from local government have been applied for (Section 34-32.5-110(i)(a)(VIII). <br />2. 'Co the best of my knowledge, all significant, valuable and petmanentman-made structure(s) inexistence at the time this <br />application is filed, and located within 200 feet of the proposed affected area have been identified in this application <br />(Section 34-32.5-11 S(4)(e), C.R.SJ. (NOTE: pot I10 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 are prohibited by law (Section 34-32.S-11S(4)(f), <br />C.R.SJ. <br />4. As the applicandoperator, I do not have any mining(exploration operations in the State of Colorado currendy in violation of <br />the provisions of the Colorado Land Reclamation Act for the Extraction ofConstruction Materials (Section 34-32.5-12Q C.R.SJ. <br />5. I understand that statementsvt the application are being made under penalty ofperjury and that false statements made herein <br />are punishable as a Class 1 misdemeanor pttrsttant to Section 18-8-503, C.R,S. 1984. <br />Thls form has been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-IIO,C RS, ojthe Colorado Land <br />Rectamation Act jot the Extraction of Construction Materiets. Any alteration or modiJFcation of this form shag result in voiding <br />any permit issued ou the uttered or modtfred form and subject the operator [o cease and desist orders and civll penalties for <br />operating without a permll pursuant to seMton 34-32.5-123, C.R.S. <br />Signed and dated this ,~D ~ day of -~ ZOO <br />If Corporation Attest (Sea]) <br />Applicant/Operator <br />Signed: <br />?M~ <br />Title: /f'1/~/V ~~~j,~Cryt,~je~ <br />State of L ~O(D~t:LGrO ) <br />ss. <br />cewttyef l~rn~era_f ) <br />The foregoing instmment was a/c~kno1w,ledged bTefore me this _-~ <br />_, by ~.L~_~1/1 ~. Pcst" fit- .J1 as <br />A~6w9J ~ ~U~apmt-~f~ GLC <br />DELLA BROWN <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />My Commission Expires 09/23/2008 <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Cterk <br />SIGNATIJRF,S MUST BF. IN BLUE INK <br />M:kninlsharatvsf<mms'Cnnstrucfim~ t t 0 (Apprsrved t1S/I !/2UOS) <br />My Cormnission expires: ~ r~"3 D ~ _ <br />