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 knowledge, all significant, valuable and permanent man-made structwe(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 />34-32.5-115(4)(fj, C.R.S.; <br />3. As the applicant/operator, I donot have any extraction/exploration operations m 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.) 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 ~o ~ day of ~~u4/'t~ ,ZOD~ <br />O/dcas~'/e ,SW 4~up, -rnc. dbq <br />Pour Cnrne~-s ~7gferials <br />ApplicanU r Company Name <br />Signed: <br />Title: Pres.~%> f <br />State of ~inCD219 <br />ss. <br />County of L/-I PLPrT7/-1 <br />If Corporation Attest (Seal) <br />,. <br />--- <br />,. <br />- '.:: <br />~: >. <br />~= <br />,^ .; = - <br />`` <br />Sign ''D <br />Corporate Secre ry or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was aclmowledged before me this _ l day of , ~R/y u w rem , z_Qo'~, by <br />~-rsie S SI EC M u Af~ as h~RE5 i j1FA )T of 6~r~SY[E S iil ~'i, 2a..r P .1, Ax . . <br />clba rou(~co2lvt'(L.S m~reP~r+tS <br />\~ suty~ <br />~~5~~$' ~ Notary Public <br />~fB®l~~C' a - <br />My Commission expires: <br />~ eta ne~~.~ <br />SIGNATURES MUST BE IN BLUE INK <br />M Min~shereWSfmms\Canstruction I1? doc (IO/I S/2001) <br />