1996-03-15_REVISION - M1977342

• Permit No: M1977342
• IBM Index Class Name: Revision
• Doc Date: 3/15/1996
• Doc Name: REGULAR 112 DESIGNATED MINING OPERATION RECLAMATION PERMIT APPLICATION FORM
• Type & Sequence: AM2
• Media Type: D
• Archive: No

-6-
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. This mining operation will not adversely affect the stability of any significant,
valuable and permanent man-made structure(s) located within two hundred (200) feet of
the affected lands. (However, where there is an agreement between the
applicant/operator and the persons having an interest in the structure that damage to
the structure is to be compensated for by the applicant/operator (Section
34-32-115 (4)(d), C.R.S. 1984, as amended), then mining may occur within 200 feet.
Proof of an agreement must be submitted to the Office prior to the decision date.)
2. No mining operation will be located on lands where such operations are prohibited
by law (Section 34-32-115(4)(f), C.R.S. 1984, as amended);
3. As the applicant/operator, I do not have any mining/prospecting coerations in
this state of Colorado currently in violation of the provisions of the Mined Land
Reclamation Act (Section 34-32-120, C.R.S. 1984, as amended) 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 18-8-503, C.R.S 1984, as amended.
Signed and dated
~~ day of ~ A'Y~

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or if Corporation Attest (Seal). "'
Signed:
Title: ~//'/F/7 ~.,C~5~-4~n/I T` ~'' ~P.~P,~
State of lJl~~~"~-~--U )
County of `~C~-Q~LJ ) /
The foregoing instrument was ac)mowledged before me this / "- day of ~~~ iiii-
by ~ as Y/ ~ f-7" / I~of l - rt (_.O
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Notary Public /
My Commission expires: ~~ 0~7~910
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(10/14/94)
_ Signed: !]~-a'"~ 77` v""~~""7t'7l
/~/ ox~eee Secretary or &quivalent
//I/p//!}6Eae Town/city/County Clerk

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