Laserfiche WebLink
-8- <br />Certification- <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 permanent man-made structures} inexistence at the time <br />tfiis application is filed, and located within 200 feet ofthe proposed affected area have been identified in this application <br />(Section 34-32.5-IIS{4}(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by law <br />(Section 34-32.5-115(4)(f), C.R.S.; <br />3. As the applicant/operator, 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 <br />(Section 34-32.5-120, C.R.S.) as determined through a Boazd finding. <br />4. 1 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 />This farm has been approved by the Mined Land Reclamation Board pursuant [o section 34-32.5-712,C.RS, of the Colorado Land <br />Reclamation Aetjor the Pxtraction of Construction Materials. 9ny alteration ar modifreation of thisform shall result m voiding any <br />permit issued on the altered or modified form and subject the operator to cease and desist orders and civil penal[ies for operating <br />without a permu pursuant to section 34-32.5-123, C.R.S. <br />Signed and dated this ~ day of ~~t ~-1- ~OZ~ ~- <br />~ypvl~ ~QM ~ HGIC Y~ G G~2-< { ~1 f <br />ApplicantJOperat r otS r Compan Name <br />Signed: ~ `/t~-t I/1 <br />Title: 6g2t,¢~,iG1 V/;otM1-.ei c~/ <br />State of ~otiDRA~y ) <br />ss. <br />County of ~ D <t vh S j <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this o~ 7~ day of /1 (,t L~ 1.( ST~I , <br />ZOO~bY_~L~omAS /NI..4ul_ as L~~NE,QgL f~n.~4L,~2 of~oti~ I°tiW-~%raE c-,c-,KcUh~ <br />QP,•~O R~•.F,t, Notary Public <br />~ ~, A <br />vT•.,C~E3e av <br />~ F•.: _C7G~N <br />lviy Commission expires: / U 30 0 <br />MUST BE IN BLUE iNK <br />Lf:Vmniclrarelvsfornn~Conswetian i 17.da (A ptOVCSr- <br />Myt,ommissbn Etpires t4t3(uZpp~ <br />