Laserfiche WebLink
<br />-~- <br />I ,t <br />Certification: <br /> <br />As an authorized representative of the applicant, 2 hereby certify that the operation <br />described has met the minimum requirements of the following terms and conditions: <br />1. To the best of my knowledge, all significant, valuable and permanent man-made <br />structure(s) in existence at the time this application is filed, and located within 200 <br />feet of the proposed affected area have been identified in this application (Section 34- <br />32.5-115(4)(e), C_R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by <br />law (Section 34-32.5-115(4)(f), C.R.S.; <br />3. As the applicant/operator, I do not have any extraction/exploration operations in the <br />State of Colorado currently in violation of the provisions of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-120, C.R.S.) <br />as determined through a Board finding. <br />4. I understand that statements in the application are being made under penalty of <br />perjury and that false statements made herein are punishable as a Class 1 misdemeanor <br />pursuant to Section 18-8-503, C.R.S. <br />ZZ Ro M <br />Signed and dated this ~J day of il~~C{~ r!8 . <br />4 ~ ~Xe-AVL~T{Nro , I~1C. <br />Applicant/Operator or Company Name <br />, ~ _ <br />Signed: / <br />Title: <br />State of ( A/k-, ) <br />ss <br />County of ~,A~(~ ) <br />Corporate Se <br />Town/Ci <br />\~ •~. <br />r~y ~ ~ i <br />oa.~g~ <br />20 <br />The foregoing instrument was acknowledged before me this ~ day of rn AQ1:41 lyr7ST, <br />by tilOnJ~~ Y. An1Cl~.a2d T as SSG ~ ~ p_ of ~ y- Q L.X (°A1.4Y.cJ 6 ~. <br />If Corporation Attest <br />Signed: <br />,~~~ <br />Notary Public ' <br />My Commission expires: A ~'c.> /.~~C/9 <br />SIGNATIIRES MAST BE IN BLIIE INR <br />06/26/97 2823FC0.112 <br />'~~ ~, ; ; <br />, ..-~ <br />~ 7 <br />