Laserfiche WebLink
<br />-~- <br />Certification: <br /> <br />As an authorized representa[ive of the applicant, I hereby certify that the operation described has me[ the minimum <br />requirements of [he following terms and conditions: <br />I. To the best of my knowledee, 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 I5(4)(e), C.R.S.). <br />2. No mining operation wiSl be {orated on lands where such operations aze prohibited by law (Section <br />34-32.5-1 I5(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 Extraaion 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 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 87~ day of JUhe 2.[x~c~ <br />M•A. CoNGrci-e Gati137KUGTtoti/, ENG. <br />Applicant/Operator or Company Name <br />Signed: <br />Title: PtsES ~ r~NT <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of `;0.~O~t?aCirD <br />ss <br />Counryof ~~eSGU ) <br />The foregoing instrument was acknowledged bef~9r~{ me this `~ day of U l1./1L°. .o2DOC~ . <br />by fYlAi2'ii,J I~ZCRiL,C~Hb'Aas Nres'tdenf off11.A.~nrefP C'On,S-1i't~Ct~raA -ANC' <br />Nora Public <br />_ ~ <br />-_~ ~ My Commission expires: (y-~ ~ -ate / <br />SIGNATURES MUST BE IN BLUE INK <br />M:NUNSF1AREiVSFORMSVCI1COIl.MP 0'J 10/9'• <br />