Laserfiche WebLink
~ xy ~ K t, 1 ,.~y r -r , <br />,y h .. E Q <br />`,:. ..• <br />Certification ., , . ~ Division d Minerals and Geology <br />As an authorized representative of the applicant, I hereby certify that the operation descnbed has met the minimum requirements of the following carats <br />and conditions: <br />r' <br />1. 'Ibis mining operation will not adversely affect the stability of any significant, valuable and permanent man-made stntcdae(s) located <br />within two hundred (200) feet of the affected lands. (However, whce there is an agreement between the applicandopera[or and the persons <br />having an interest in the stmcnne that damage to the atmcdae is to be compensated for by the applicanVoperator (Secflon 834-32-115(4)(d), <br />CR.S..1984; as amended), then mining may occur within 200 feet Proof of an agreement must be submitted to dte Office prior to the dectision <br />date) <br />- 2.. No mining operafion will be located on lands where such operations are prohibited bylaw (Section 34-32-115(4)(f), C.RS. 1984, <br />as amended): <br />3. As the applicandoperator, I do not have any mining/prospecting operations in this state of Colorado,currently in violation of the <br />provisions of the Mined Land Reclamation Act (SectiOon 34-32-120, C.R.S. 1984, as amended) as determined through a Boazd finding. . <br />k <br />4. 1 understand that statements in the application are being made under penalty of perjury and that false statements made herein az% <br />punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S 1984, as amended. •~ <br />Signed and dated this _~ day of ~,Q D `J <br />Ju+~n Ft N-P Go'a Coy .PC'{`~~r <br />Applican perator or Company Name <br />Signed: N-Q~ ~t ~ -. <br />Title: `~ac~m.-,c~1 t•.,•-. t'"ls..acv/ <br />If Carporafion Attest (Seal) <br />i. ~ ~ . <br />Signed: ~ _ -~~ ~d61 <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of l_1.9-~~~ 1 <br />((~~ ) ss. <br />The foregoing instrument was acknowledged before me this . ~~ day of n tl~ . ~D3 <br />by LLrrC.i Perim as~j - ~~,,j~eL'„J~otipc~e~ of ~tan~caS(de~tolt~ Coc(~. <br />P <br />BEVERLY <br />NOLMER <br />OF <br />Ssi~ ~.l_>.~p~t~-Pmt~__ <br />Notary Public <br />My Commission expires: ~-/R -b~ <br />SIGNATURES MUST BE IN BLUE INK <br />M:VvIINtBDCtMINFORMS~2823HR12APP (10/152001) <br />