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 Imowledge, all significant, valuable and permanent man-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 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 <br />34-32.5-113(4)(f), C.RS.; <br />~. As the applicant/operator, I do not have a~ extraction/explorationoperations mthe 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.RSJ 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.RS. <br />Signed and dated this ~Q~ day of ~ ~ ~ o o ~ <br />(tfoRGF F. (3-At_t.,E ~,,f <br />Applicant/Operatm or Company Name <br />Signe~~ <br />Title: ~alir'7G[a¢~r/ <br />State of ~O (ors d8 ) <br />ss. <br />County of t~,o y~ r o S <br />The foregoing instrument was aclmowledged before me thi Or~ day of _ <br />~~.en l~ovw. as of <br />Pubhc <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/Ciry/County Cleric <br />My Commission expires: <br />SIGNATURES MUST BE IN BLUE INK <br />~20o by <br />,.~.. . <br />=_ ~ ``% <br />~. <br />.~ <br />a .~ ~ 1 - <br />~~r n~ <br />r <br />M:win~shue\vsrmrtn~Cmiwuctian 112.doc Oat52aot) <br />