Laserfiche WebLink
<br />~- <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 />I . To the best of my knowledge, all significant, valuable and penttanentman-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 applirntion <br />(Section 34-32.5-115(4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by law <br />(Section 34-32.5-115(4)(f), C.R.S.; <br />3. As the applicant/operator, l do not have any extraction/explorationoperations 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.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 />This jarm has been approved by the Mined Land Reclamation Board pursuan! to section 34-32.5-171,GR.S., ojihe Colorado Land <br />Reclamation Aet jar the Extraction of Constructiox Materials. Any alteration ar modification of this form shat! result in voiding any <br />permit issued on the ahered or modified jarm and subjec[ the operator to cease and desist orders and civil penaltiu for operating <br />without a permitpursuant to section 34-31-IZ$ C.R.S <br />fined and dated this \\'~41 day of S f~l~yA~ `{ d ~~$ <br />L.OK f. ,,.e „ t~ f /t4 o fie ~ ~./~ e.o r~r If Corporation Attest (Sea <br />ApplicandOperator or Company Name <br />Signed: S Signed: <br />Corporate Secretary or Equivalent <br />Title: ~ yCE Q RES~OEUT Town/City/County Clerk <br />State of ~L [ in/d IS' <br />ss. <br />County of eo~~' 1 <br />The foregoing instrument was acknowledged before me this /~~ day of cu-cLt.~ , a00.~ /~ <br />_, by ~o5=r'%~ S SuN as VIeE {~2~'StdEA1T of ~~'tii lAlclJ; AL MA~Eh~1Ri-3C:o~tq <br />OFFICIAL SEAL Notary Public <br />ANNEMARIE B NUSEKABEL <br />rorNtrvum,c.sr~haFwtafe g,aa _o g <br />-trCOWBggN~ My Commissionezpires: <br />SIGNATURES MUSTBE IN BLUE INK <br />M1minWue\vsfomisYCm,arvciimi li3.doc f07RBf10U4) <br />