Laserfiche WebLink
S- <br />Certification: <br />As an authorized representative of the applicant,) hereby certify that the operation described has met the motnnum requirements of <br />the following [emts and conditions: <br />l . To the best of my knowledge, all significant, valuable and pertnanentman-made structure(s) in existence at the time this <br />application is filed, and located Hhthin 200 fed of the proposed affected area have been identified in this application <br />(Sxtion 34.32.5-115(4)(e), C.RSJ. <br />2. No mining operation will be located on lards where such operations are prohibited by law <br />(Section 34-32.5-I15(4)(f), C.R.S.; <br />3. As the applicanUapera[or, I do not have arty extraction/exploration operations in the State of Colorado currently in <br />violation of the provisions oC [be Colorado Land Reclamation Ad for the Extraction of Construction Materials <br />(Section 34-32.5-120, C.RS J as ddertnined through a Board finding. <br />4. I understand that statements N the application are being made order penalty of perjury• and that false statements made <br />herein are punishable as a Class 1 misdemearar pursuant to Section 18-g-503, C.R.S. <br />This jorm has been approved by the Mined Land Recloinatian Board pnnaan! to section 30-32.5-112,C.RS., ojthe Colorado Land <br />Reclamation Actjor the Extraction of ConstwrYion Materiab. Any aCerafion or modification ojthu jorm shall resaU in voiding any <br />permit issuedon dre altered or modifiedjorm and rabjertthe apualor to Beare and desistorders andrnUpenadriesjor operaGng»mhawf <br />a permit pwsam#to sedinn 3J-32.5-123, C.RS. <br />Signed and dated this lye day of N~t~~d v/~~Pt/ 'LOU~ <br />_~a~2v~ ~~ L(~ <br />Applicam/Cperator or Comparry ame <br />Signed: <br />Tide: f`rizv» tio,i <br />./-~ <br />State of ~W U`R-~ d ) <br />/~ ) ss. <br />County of ~Q /"l~ ) <br />If Corporation A[tcst (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing insrnanen[ was acknowledged before me this /S `day of <br />by Y1?atf- ~ Cu/'vt.thsfvt as~tr or <br />Notary <br />My Commission expves: <br />SIGNATURES MUST BE IN BLUE IIYI{ <br />M.s~w~war~+;cave,..,~on i iz a« Inppro~:a osit tnoosl <br />