2004-10-20_REVISION - M1978080 - Laserfiche WebLink

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6- Certification: As an authorized representative of the applicant, I hereby certify that the operation described has met the minimtun requirements of the following terms and conditions: I. All necessary approvals from local government have been applied for (Section 34-32.5-110(1)(a)(viii). 2. To the best of my lmowledge, al] significant, valuable and permanent man-made strucUae(s) in existence at the time this application is filed, and located within 200 feet of the proposed affected azea have been identified in this application (Section 34-32.5-I15(4)(e), C.R.SJ. (NOTE: For 110 operations, the affected azea includes all lands delineated by the perrnit boundary.) 3. No mining operation will be located on lands where such operations are prohibited by law (Section 34-32.5-115(4)0, C.R.S.). 4. As the applicandoperator, I do not have arty mining/prospecting operations in the State of Colorado currently in violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-120, C.R.S.). 5. I understand that statements in the application aze being made under penalty of perjury and that false statements made herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. 1984. Signed and dated this 14 day of 0 c t ob e r Don Blake for Lincoln County Appliic~UOperator Si ed: 'V ?'~ - Title: Land Use A State of Colorado ss. Countvof Lincoln ) Town/Cit7~fCounty C-eik The foregoing instrument was aclmowledged before me this 1 ~k~% day of ~i-1-e~ , _,a '0~' , by ~ sr ~Z~ ~~ _ as ~.n..~ lt~.t /-lp rv~ ~ r~ l s~1r M~-a,( of ,. _; Y, co` Notary Public 2004 If Corporation Attest (Seal) Sited: Corporate Secretary or Equivalent My Commission expires: ~~ - ~.`~' ~ott5 SIGNATURES MUST BE IN BLUE INK M:\min~share\vsfonns\Conswaionll0 (05/06@003)