Laserfiche WebLink
~ ~~I ~I~~I~~II I . RECEIVED <br />., - ~ NOV 01 2001 <br />Division of Mqinerals and Geology <br />Certification: r,_/~~O ~a~~ <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements <br />of the following terms and conditions: <br />1. To the best of my knowledge, all significant valuable and permanentthan-made structure(s) in existence at the time this <br />application is filed, and located within 200 feet oC the proposed aBected area have been identified in this application <br />(Section 34-32.5-115(4)(e), C.RS.). <br />2. No mining operation will be located on lands where such operations are prohibited by law (Section 34-325-115(4)0, <br />C.RS.; _ <br />3. As the applicant/operator, I donor have any extractiom/exploration operations in the State of Colorado cturently 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.R.S.) as determined through a Board finding. <br />4. I understand that statements in the application are being [Wade under penalty of perjury and thaz false statements made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. <br />Signed and dated this ~ day of (~C fO /7 e /' ~ 0 ~ / <br />L-d a 2h Co ~~~~ <br />Applic Operator or Company Name <br />SignedCA/u=~-- b l~ <br />Title: C ~ K h ~~! p/a h h 2 /' <br />State of CO~b~f0. <br />Tewe//County Clerk <br />ss <br />County of _~Qin„ ) <br />The foregoing instrument was acknowledged before me this ~ ~ day of OL t t~ya r a ~ J , <br />by ~ r\~ ~"VnhSnn as ~u n't~.t Q (0.nrter of ~q4 n ~O U n >~., <br />`p , <br />No ublic <br />My Commission expires: 1q ~ 3G0 <br />If Corporation Attest (Beall <br />Signed: ~.~- <br />t <br />SIGNATURES MUST BE IN BLUE INK <br />