Laserfiche WebLink
- 6 - <br /> Certification: <br /> As an authorized representative of the applicant, I hereby certifi that the operation described has met the minimum requirements of the <br /> following terms and conditions: <br /> 1. All necessary approvals from local government have been applied for(Section 34-32.5-110(1)(a)(viii). <br /> 2. 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 34-32.5-1 l5(4)(e), C.R.S.). (NOTE: For 110 operations, the affected area includes all lands delineated by the permit <br /> boundary.) <br /> 3. No mining operation will be located on lands where such operations are prohibited by law(Section 34-32.5-115(4)(f), C.RS.). <br /> 4. As the applicant/operator,I do not have any mining/prospecting operations in the State of Colorado currently in violation of <br /> the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials(Section 34-32.5-120,C.R.S.). <br /> 5. I understand that statements in the application are being made under penalty of per ury and that false statements made herein <br /> are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R S 1984. <br /> Signed and dated this _day of (/' t 4r '�Q b ) <br /> 1,�c4c't- If Corporation Attest(Seal) <br /> Applicant/Operator <br /> p' f <br /> c� <br /> Signed: Signed: <br /> rare �' <br /> Corporate Secretary or Equivalent <br /> Title: Ow" , Town/City/County Clerk <br /> State of� - ) <br /> )ss. <br /> County of Z?rl -tJ,J ) p <br /> The foregoing instrument was acknowledged before me this 4 day of 2Oo O by <br /> as of <br /> �Q V. y <br /> I co..."P <br /> z <br /> O: Notary Public �- <br /> 1i6;. <br /> ......PO m a <br /> My Commission expires: <br /> STATE OF <br /> SIGNATURES MUST BE IN BLUE INK <br /> M:W MSHARE\VSFORMS\2821COIO.APP 06/25f99 <br />