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 structure(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.SJ. <br />2. No mining operation will be located on lands where such operations are prohibited by law (Section <br />34-32.5-I15(4)(fj, C.RS.; <br />3. As the applicsnUoperator, I donot 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.) as determined through a Boazd fording. <br />4. I understand that statements in the application aze 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 _~ day of ./~l <br />21ST /YIF~7b,!°aI,FLS~L•L•G• <br />ApplicandOperator or Compaq Name <br />Signed: <br />If Corporation Attest {Seal) <br />Signed: <br />Title: <br />State of ~Gz ) <br />+, ) ss. <br />County of ~ ~ t~uf CS~e.~l~-- 1 <br />The foregoing instrument was acknowledged before me <br />~lj~a\ S~ f-lar~~ as Co r\'~ro <br />~ ~oz_.•; .... .. <br />~~ <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />IS' ,-. _ - <br />~~. <br />.;`~~ <br />.i <br />=day ofd 1 \ G-c~- Yl ~, by <br />t Public <br />My Commission expires: 7~' <br />SIGNATURES MUST BE IN BLUE INK <br />M:\min~sherc\vsfo~ms\C`ooswction 11'?.doc (10/152(IOI) <br />