Laserfiche WebLink
i • <br /> Certification: <br /> As an authorized representative of the applicant,I hereby certify that the operation described has met the nunimum requirements <br /> of the following terns 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.R.S.). <br /> 2. No mining operation will be located on lands where such operations are prohibited by law(Section 34-32.5-115(4)(I), <br /> C.R-S.; <br /> 3. As the applicanttoperator, 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 (Section <br /> 34-32.5-120, C.R.S.) as determined through a Board fording. <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.R.S. <br /> Signed and dated his e* day of <br /> II <br /> no-cV 61 -%an-t _ If Corporation Attest(Seal) <br /> Applicant/Operator or Company Name / <br /> Signeft — Signed: U/ ' <br /> Title: C k-�>oAR-b pp 6v\t ASS ov-c-t -e- -Tewnieityicounty Clerk <br /> State of <br /> )ss <br /> County o£ 'r) <br /> The foregoing instrumentt�was acknowledged before me this _day of &�-'L <br /> by as CN a m r�c Lr YRn 1j o F�mr� <br /> Notary Public <br /> My Commission Expires <br /> My Commission expires:09-23-2002 <br /> SIGNATURES MUST BE IN BLUE INK <br />