Laserfiche WebLink
<br />-~- <br />Certification: <br />As an authorized representative of the applicant, t 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 34-32.5-1 IS(4)(e), C.R.S.). <br />2. No mining operation will be Located on lands where such operations aze prohibited by law (Section <br />34-32.5-115(4)(f), C.R.S.; <br />3. As the applicanUoperator, I do not 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.R.S.) as determined through a Boazd fmding. <br />4. [understand that statements in the application are 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.R.S. <br />Signed and dated this __,~___ day of ~~ ~ a o0 d. <br />DUCKELS CONSTRUCTION, INC. `~ ~ If Corporation Attest (Seat) <br />ApplicanUOperator or Company Name ~ ` <br />Signed: Signed: n (~ Y ~e A 0 X ~,~ <br />Corporate Secretary or Equivalent <br />Title: <br />PRESIDENT <br />State of COLORADO ) <br />ROUTT ) ss <br />County of ) <br />Town/City/County Clerk <br />The foregoing linstrumenpt was acknowledged before me this ~_ day of ~ ~ t o~ 00~ , <br />by Fred t-F . J~i,Cc It~!_S as ~rf(S i c~ t ~. -} of ~Cr 1~~5 5~t'ic c710"Yl , _r/r:: <br />~ :~ <br />otary Public ~ - ' <br />1 <br />My Commission exp.es: ~ r ~ ~ 0 ` `> <br />.. <br />SIGNATURES MUST BE IN BLUE INK ~-'~"`~ <br />M:N9MSHARElVBFORM8~2827C012.APP 02/10/99 <br />