Laserfiche WebLink
-8- <br />Certittcation: <br />As an authorized representative of the applicatrt, I hereby certify that the operation described has met the mittimum mgtrirements <br />of the fotlowing terms and condi[ions: <br />1. To the best of my lmowlodge, all significant, valuable and permanent man-made strucnrre(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(4xe), C.R.S.). <br />2. No mining operation will be located on lands where such operations aze prohbited by taw <br />(Section 34-32.5-115(4xf), C.R.S.; <br />3. As the applicant/opetator, I donor have any extraction/exploration operations in the State of Colorado curremty in <br />violation of the provisions of the Colorado Laztd Reclamation Acl for the Extraction of Construction Materials <br />(Section 34-32.5-120, C.R.S.) as detemrined through a Boazd 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 punishabte as a Class 1 misdetneanor pursuant to Section 18-8-503, C.R.S. <br />Thu jorm has been approved bylhe Mfned Land Reclamation Board pursuant ro sedfon 31-3A5-1I2,C.RS, ojthe Colorado Land <br />ReclamatlonActjo~theF.xtractlonojConstructionMaterials. AnyaGeraHoaormodiJicalfonofthisjormsballresuktovoidingany <br />permit issued on the altered or modfJled form and subject the operator fo uase and desi+t orders and civil penalties jot operarhrg <br />whhout apermit pursuant ro section 34-325-123. QRS. <br />Signed and dated this ~ lGD day of U V(~i~~ , ~_. <br />AppI~O ~ a or or~ y , ame <br />signed: N ck /~ <br />Title: ~ Nn.~ <br />State of L,`~~~ - ~' ~ C~ ) <br />tom" ) ss. <br />County of ~ ~1 Y \~{-~ } <br />If Corporation Attest {Seal) <br />Signed: <br />Corporate Secre or Equivalent <br />:ounty Cierk <br />The foregoing instrument vas acknowledged before me [his ~ r ~ day of "I ~C.t-1r12~~9o~~~J`(~ <br />