Laserfiche WebLink
,- <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 structure(s) in existence at the time this <br />application is filed, and located within 200 feet of the proposed affected azea 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 34-32.5-115(4)(f), <br />C.RS.; <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 Constmction Materials (Section <br />34-32.5-120, C.RS.) as determined through a Boazd finding. <br />4. I understand that statements in the application are being made under penalty of perjury and that false statements made <br />herein aze punishable as a Class 1 misdemeanorpursuantto Section 18-8-503, C.RS. <br />Signed and dated this day of , <br />ApplicanUCperator or Company Name <br />Signed. _ <br />Title: ~~~ G~-r,!/1 <br />State of'~ ~?~ \ t C`-L~~C~L~ <br />ss <br />Co of f~~ /, 1v`l~ ) <br />The`f~regoing ' stru/m~ ennt was ackno ledged <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />me this ~ ~ day <br />My Commission <br />~C~f <br />SIGNATURES MUST BE IN BLUE INK <br />