Laserfiche WebLink
8- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requiretttetus <br />of the following terms and conditions: <br />i. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) inexistence at the time <br />[his application is tiled, and located within 200 fcet of the proposed affected area have been identified in this application <br />(Section 34-32.5-115(4xe), C.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by law <br />(Section 34-32.5-1 IS(4xf), C.R.S.; <br />3. As the applicant/opcrator, I donor have any extraction/exploration operations in the State of Colorado curretttly in <br />violation of the provisions of the Colorado Land Reclamation Act for the ExtraMion of Construction Materials <br />(Section 34-32.5-120, C.R.S.) as determined through a Boazd finding. <br />4. I understand that statements in the application are being made under penalty otperjury and that false statements <br />made herein aze punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. <br />Tkis form has been approved by tht Mined Land Redamelloa Board parsaant to uctioa 34-3Z5-]12,C.RS., oftke Colorado Load <br />iteelamation Act for tke F.xiraetlon ojConslractian MaterlaLr. Any alteration or modlJlcalioa of fklsjorm skaR result In voidkrg any <br />permit ksard on fbe altered or modl jied form and sabjecl tke operator to ceau and desist orders aad clvll penaklrs for operating <br />without a permk pursuant to section 31-3I.5-I73, C.RS <br />Signed and dated this .~_ day of •~-~ --, ~D / `'~A•x <br />Gam"' <br />Applicant/Operator or Company Namc J <br />Signed: <br />^ <br />~~°J ~~pP~,i <br />signed: ~` S <br />If Corporation Attest (Seal) ~~~ ~~~•{~ <br />~J ~ ~~ Corporate Secretary or Equivalent <br />Title: ~~COrJ~~ Town/City/CountyCterk <br />State of _ (~d~>'Ga-LS y ) <br />County of ~ ) <br />The foregoin msWm t w acknowledged before mepthis ~~ day of %//Lie/ ~~/ <br />_. by _~~ ~ _ as 1 5/ /~ f uaf .ie S~•rc tsr >< <br />/-1`io~~v Public <br />S[GNATUl2ES <br />M:V,dn'aM,eWnrommYbn,p,~ip,In.dx (Approved OS/1120(ISt <br />arty or <br />~', ,G.. <br />~,~~~` ~ , INK <br />expires: ~-/~~aa <br />