2002-08-20_REVISION - M1977344 - Laserfiche WebLink

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Certification: - 7 - ~=u;; i ~ i~~~ ,': _ - -; As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements of the following terms and conditions: 1. To the best of my knowledge, aIl significant, valuable and permanent man-made structure(s) in existence at the time this application is filed, and located within 200 feet of the proposed affected area have been identified in this application (Section 34-32.5-115(4)(e), C.R.S.). 2.. No mining operation will be located on lands where such operations are prohibited by law (Section 34-32.5-I IS(4)(f), C.R.S.; 3. As the applicant/operator, I donor have any extraction/exploration operations in the State ofColorado cturently in violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Majerials (Section 34-32.5-120, C.R.S.) as determined through a Boazd finding. 4. I understand that statements in the application are being made under penalty of perjury and that false statements made herein are punishable as a Class 1 misdemeanor pursuant to Section 18-5.503, C.R.S. // Signed and dated this _~~/ day of L~A 1 LL• CJ_~ _ ~~ ,~~;~~. I i7~ ~ (~~~ r~1~C.. ApplicandOperator or Company Name Sired: ~~/ /// ~- ~// i / _ /-) ~ i Title: ~ l i /Ci_ !JU / .r ! ~ ~~~.~% /~. /, State of /i i~ (1 ~~~ ) ~ ~) s~ If Corporation Attest (Sea]) Signed: /,~''~1 f~'l"t • ~-t.c.eF Corporzte Secretary or Equivalen~. Town~City/County Cler}: County of vn r- ;~ f„( i ) ~` ~ The foregoing insmrment was ackno~ ledged before me this ~ ~ day of :~~IJ~J; `I . ~.!-, -, L ;; ~ . by. ,.1~,;~(`li ~. t 2i /uCU"(-1/ ~/%i i</ILr. Of Y'",.1c ii ?:-1~.:~i ~'r~ ~ / ~.~ 1- i1/Y',i i .. - _ / ~; I',1 FiECEIVE® ~ LL7-G ~~~,~7,%;r''~%',-,~1- AUG 2 ~ ~(~ Notary Public `- C' ~. Division of Minerals and 6e, i~BY My Commission expires: I ~ 1 / / ~ . ~ ' ~ SIGNAURES MUST BE IN BLUE L~iK