Laserfiche WebLink
<br />- 7 - <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum <br />requirements of the following terms and conditions: <br />l . 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-I li(4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations are 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 Extraction 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 3rd day of ~n v~ . n r ~ , 2A[~ t <br />Fvor .~a~e`~ ra3a+e5 <br />ApplicanUOperator or ompany Name <br />:, , <br />,~~_ <br />if Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Title: Nl3rte6pl' <br />--~ <br />State of Go try t-~ ) <br />ss <br />County of _ Maft'rc: z.UmB ) <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this fir d day of .~O,v~taar u 2OO t , <br />~by 1eSr~ Zi Gorsuch as tvl~r of [=n~i; ~ir~~cs Anaraa¢~rs 1_ll: <br />T~ <br />~~ ~~~~ <br />Notary Public <br />My Commission expires: ~- 22- 1.A(S~ <br />.: <br />SIGNATURES MUST BE iN BLUE INK <br />M:UOMSHARE~~SFORMSVBIlC013.MP oviaw <br />