Laserfiche WebLink
NOV ~ 92001 DEC 3.1 ZQaI <br />CertiTication: Gioiaian of Wlit>arals and Geology '" btinarals and Geology <br />an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements of the <br />following terms and conditions: <br />All necessazy approvals from local government have been applied for (Section 34-32.5-110(1)(a)(viii). <br />2. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence at the time this <br />application is filed, and located within 200 feet of the proposed affected azea have been identified in this applicalion (Section 34-32.5- <br />1 I5(4)(e), C.R.S J. (NOTE: For 110 operations, the affected azea includes all lands delineated by the permit boundary.) <br />No mining operation will be located on lands where such operations aze prohibited bylaw (Section 34-32.5-I15(4)(f), C.R.S.). <br />4. As the applicant/operator, I do not have any mining/prospecting operations in the State of Colorado currently in violation of <br />the provisions of the Colorado Lazid Reclan',ation Act for the Extraction of Consirucuon i taterials (Section 34-32.5-120, C.R.S J. <br />5. I understand that statements in the application aze being made under penalty of perjury and that false statements made herein <br />aze punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S 1984. <br />Signed and dated this ~ day of N d J~ /!1 ~~ 2Gd l <br />.y.~ .. "~~ /' <br />. A , <br />-i <br />~~ l.tltnKOrJErJ BIOS. 5ia1JE CO. <br />Applicant/Operator <br />Signed: ~~1 <br />Title: G.EnIt~AL 21~1/1./rtGfiP ~1~/ <br />State of C.D~o'~ G-~ O ) <br />- - -~ ss. <br />County of ~j ~~ ~\ ~ e.`f ) <br />If Corporation Attest (Seal), 'y 1 <br />~, ~~ <br />~. r <br />~; ~ -, <br />Signed( /~JI' /~~A ~!~~1.(J~ <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this o~ ~n day of ~ ~V ~ , ~~, by <br />~c'C~~~-e. ~.ou~,~~.ax~ as ~s~r~rc\ mc~~o.c~ ear of ~.a>,~.~o~,~ c~1~CD. <br />~~ <br />~..+. ;~ _ No Public <br />`- ~:> ~ - My Commission expires: <br />= .~, _ ;° b. 5, 2005 <br />' " ~ SIGNATURES MUST BE IN BLUE INK <br />M:\MIN~SHARE\VSFORMS\2821CO10.APP 10/IS/Ol <br />