_PERMIT FILE - M2000002 ‎(18)‎

• Permit No: M2000002
• IBM Index Class Name: Permit File
• Doc Name: CONSTRUCTION MATERIALS REGULAR 112 OPERATION RECLAMATION PERMIT APPLICATION FORM
• 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 minimum requirements of the following terms and conditions:
1. To the best of my knowledge, all significant, valuable and permanent man-made
structure(s) in existence at the time this application is filed, and located within 200
feet of the proposed affected area have been identified in this application (Section 34-
32.5-115(4) (e) , C.R.S. ) .
2. No mining operation will be located on lands where such operations are prohibited by
law (Section 34-32.5-115(4) (f) , C.R.S. ;
3 . As the applicant/operator, I do not have any extraction/exploration operations in the
State of Colorado currently in violation of the provisions of the Colorado Land
Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-120, C.R.S. )
as determined through a Board finding.
4. I understand that statements in the application are being made under penalty of
perjury and that false statements made herein are punishable as a Class 1 misdemeanor
pursuant to Section 1188-8-503, C.R.S`.
Signed and dated this J day of C . Qd
If Corporation Attest (Seal)
plicant/Operator or Company Name /
Signed: Signed: ,✓�
L_ � � �, Iny�,�J- �� ' . Corporat ^ ecretary or Equivalent
Title: �1 AV,401 G�X /`u<*^^�[.Q..l Town/City/County Clerk
State of C&4 )
1 ) ss
County of " )
The foregoing instrument was acknowledged before me this ' day of 26a N_ Z Otn!�
IQ
by as .'Se_n t Loom Mot.,Q.3V of /No� o `.. 1 ✓ 1 ne C_ e*"_1—ft<
WO
% ,
` Notary Pub is
My Commission expires: 1(.,- C1a cy-.N 1
s-`%.UB 'r
ST 88 IS BLUE INK
06/26/97 2823FCO.112