Laserfiche WebLink
-8- <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 />t. 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 34-32.5-115(4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations aze prohibited by law <br />(Section 34-32.5-115(4)(f), C.R.S.; <br />3. As the applicant/operator, I do not have any extractioNexploration operations in the State ofColorado 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.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 1 g-g-503, C.R.S. <br />This jarm has been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-111,C.R.S., ojehe Colorado Land <br />Reclamation Act for the Exeraerton of Construction Materials. Any alteration or modifteation of this form shall result in voiding any <br />permit issued an the altered or modified form and subject the operator to cease and desist orders and civil Pena/ties jor operating <br />without a pernti! pursuant to section 34-32.5-113. C.R.S. <br />Signed and dated this ~ day of _ ~ ~ Gift ~ ZOD S <br />_,4n ~QS ~ f~9`„~te ~ui /~!r ~ /Qaw~t~-~ If Corporation Attest (Seal) <br />ApplicanUOperator orCompany Name <br />Signe <br />Signed: <br />Corporate Secretary or Equivalent <br />Title: <br />Stale of (.,~o rq~p <br />ss. <br />County of Moref a rt <br />Towrl/City/County Clerk <br />The foregoing in~strumem was acknowledged before me thi day of5 J LL VL e- , <br />`ZOOS, by 1,~ 1mL 5 s. /yl ~ n e cr as (!Si Q n f of <br />r4retrate,n!rrtrrhrrr./ r <br />` ,,. <br />fie;. , '>~'^;:'•C/,;`~'"s o ublic <br />~~: ~~ g'1'~ 7! R" ~'. e - 1,4y Commission E>~ites <br />`' ' °'° ~ ~ ° My Commission expires: 1161"/ <br />~,: ~ = <br />SIG~AIA~fRE9`;4lif,Sfi`BE IN BLUE INK <br />M:LninUharclvsfonnslCanstnutian 112Aac (Appmved OSII <br />