Laserfiche WebLink
-~- <br />Certi£cation: <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 fled, 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.RSJ. <br />2. No mining operation will be located on lands where such operations are prohibited by law (Section <br />34-32.5-115(4)(f), C.RS.; <br />3. As the applicanUoperator, I do not 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 (Section <br />34-32.5-120, C.RS J as determined through a Boazd fmding. <br />4. I understand that statements in the application aze being made under penalty of perjury and that false statements <br />made herein aze punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. <br />Signed and dated [his ~ ~ -~' day of ~~ , <br />1 ~ ~ ~='~ ~~-r~ • ~ If Corporation At[est (Seal) <br />ApplicanUOperator or Company Name <br />..~..~, - <br />Signed: Signed: <br />i <br />Q Corporate Secretary or Equivalent <br />Title: Town/City/County Clak <br />State of C-1-1~~ 1 <br />ss <br />County of ~ v u ) <br />The foregoing instrument was acknowledged before me this ~ ~1 n day of S I~P~1-- , ~> <br />by as of <br />~V~(~1Y1 ~ ~ r ' <br />Notary Public <br />My Commission expires: ~ `~`~ <br />SIGNATURES MUST BE IN BLUE INK <br />M:U1Q.~BDCNfINFORMSV.823C012.APP 10/l7/Ol <br />