REV92924

• Permit No: M1978078
• IBM Index Class Name: Revision
• Doc Date: 7/16/1997
• Doc Name: application
• From: DMG
• To: LINCOLN CNTY BOARD OF CNTY
• Type & Sequence: AM1
• Media Type: D
• Archive: No

-6-
Certification:
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. All necessary approvals from local government have been applied for
(Section 34-32.5-11O(1)(a)(viii).
2. To the beet of my knowledge, all significant, valuable sad 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.). (NOTE: For 110 operations, the affected area includes all lands delineated by the
permit boundary.)
3. No mining operation will be located on lands where such operations are prohibited by law
(Section 34-32.5-115(4)(f), C.R.S.).
4. As the applicant/operator, I do not have say 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 are 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 sad dated this 8th day of July :997
Li:lcoln County If Corporation Attest (Seal)
Applicant/~O~pe~r~ato((~~r //
Signed ~4~~'XJ U [.(~L~ .(~` Signed: ~`Y-o~-~-0- ~ a^rc^-°
Corporate Secretary or Equivalent
Title: Chairman Lincoln County Comraissionors -4oalr/CitpyCounty Clerk
State of Co.lorzc'c )
ss
County of Lincoln )
The foregoing instrument was acknowledged before me this nth day of Jule 1997
by Gerry Stce;c ill
Ol/02/%ffi21FC0.110
as
J
of Linccl.n Cc. Co«:i;?.:sion.r~
My Commission expires:
SIC'li1174RES !![1ST SE IH HLIIE INR
C~lu l rmat";