Laserfiche WebLink
-~- <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 />1. 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 ofthe proposed affected area have been identified in this application <br />(Section 34-32.5-I15(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, I donot 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 <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 form has been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-112,C.R.S., of the Colorado Land <br />Reclamation Act jor the extraction ojConstruction Materials. Any alteration or modification of this form shat! result in voiding any <br />permit issued on the altered or modified form and subject the operator to cease and desist orders and civil penalties for operating <br />without a permit pursuant to section 34-32-123, C.R.S. <br />Signed and dated this day of NOVEMBER 2004 <br />JACKSON COUNTY ROAD AND BRIDGE If Co oration Attest Seal +yn ~. <br />ApplicanUOperator or Company Name <br />Signed: r <br />Title: CHAIRMAN <br />State of COLORADO ) <br />ss. <br />County of JACKSON <br />The foregoing instrument was acknowledged before me this day of November . 2004 <br />by Richard F. Wyatt as <br />AR j <br />SIGNATURES MUST BE IN BLUE INK <br />Signed: L% <br />Corporate <br />.y <br />,~:% <br /> <br />~shareAvsdoc (0728/2004) <br />My Commission 6~Ires8-182008 <br />My Commission expires: > ~ <br />