Laserfiche WebLink
- 7 - <br /> Certification: <br /> As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum <br /> requirements of the following terms and conditions: <br /> 1. To the best of my knowledge, all significant,valuable and permanent man-made structure(s) in existence at the time <br /> this application is filed, and located within 200 feet of the proposed affected area have been identified in this application <br /> (Section 34-32.5-1 15(4)(e), C.R.S.). <br /> 2. No mining operation will be located on lands where such operations are prohibited by law(Section <br /> 34-32.5-115(4)(0, C.R.S.; <br /> 3. As the applicant/operator, I do not have any extraction/exploration operations in the State of Colorado currently in <br /> violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials (Section <br /> 34-32.5-120,C.R.S.)as determined through a Board finding. <br /> 4. I understand that statements in the application are being made under penalty of perjury and that false statements <br /> made herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. <br /> Signed and dated this day of <br /> L 6 6 G l �l� If Corporation Attest(Seal) <br /> Applicant/Operator or Company Name <br /> Signed: Signed: <br /> Corporate Secretary or Equivalent <br /> Title: Town/City/County Clerk <br /> State of l Ql L �Q ) <br /> ss <br /> County of / I u d �� <br /> The foregoing instrument was acknowledged be�f/�jr�a�m(ethis �`� day of Y) <br /> by t as TGVI T of <br /> TA/� <br /> O- kaPubl�jc <br /> aqMy Commission expires: <br /> SIGNATURES MUST BE IN BLUE INK <br /> M:IWMSEAADVSFOP.MS\2823CO12APP OZ11009 <br />