Laserfiche WebLink
8- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minim~uu requirements of <br />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 this <br />application is filed, and located within 200 feet of the proposed affected area have been identified in this application <br />(Section 34-32.5-115(4)(e), C.RS.). <br />2. No mining operation will be located on lands where such operations are prohibited by law <br />(Section 34-32.5-115(4)(£), C.RS.; <br />3. As the appGcandoperator, 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 <br />(Section 34-32.5-120, C.RS.) as determined through a Boazd finding. <br />4. I understand that statements in the application are being made under penalty of perjury and that false statements made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. <br />This jorm has been approved by the Mmed Land Reclamation Board pursuant to section 34-31.5-112,CRS., ojthe Colorado Land <br />Reclamation Ad joy fhe Fa9radion ojConsbudion MaterinLs. Any alteration or modiftcalion ojthis jorm shag rtvult in voiding any <br />permit issued on tke altered or nwdifiedjorm and subject the operator to cease and desist orders and civilpenaXiGS jot opaaA'vrgrWhout <br />a permit pursuant to section 34-32.5-123, CRS <br />signed and dated this 2l sF day of S¢.R~?un ~O2y .2uu ~ <br />~~ 1 ~'~' If Corporation Attest (Seal) <br />plicant/Opeyator or Company Name <br />Signed: ~~~~ ([!,~ / Signed: <br />Title: <br />State Of CaCCG~~t~~O <br />) SS. <br />County of ku p~a~q, ) <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was aclmowledged before me this c~-1 St day of 52{1~k.1,~t 1~ er <br />by ~TvcQc~ 1~ . ~(sketr as VIn0.twa~e,r of ~gGt2 ~t_l-C, ,.~~~t <br />~~ <br />SIGNATURES MUST BE IN BLUE INK <br />M ~en,K~y~~c~e~ i izaa <approvea osn inoosl <br />My Commission expires: JriW~ l3 49 <br />