Laserfiche WebLink
~- <br />Certification: <br />As an authorized representative of the apphcant, I hereby certify that the operation described has met the minimum <br />requiremems of [he following terms and conditions: <br />1. To [he 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 34-32.5-115(4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by law <br />(Sechon 34-32.5-I15(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 34-32.5-12Q 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 />This jorm has been approved by the Mined Land Reclamation Boardpursuant to section 34-31.5-111,0 R.S., ojthe Colorado Land <br />Reclamation Act jar the F.xtraclion aJConstruction Materials. Any alteration or modification ojlhls jorm shall result in voiding any <br />permit issued on the altered or modtfred jorm and subject the operator m cease and desist orders and civil penalties jor operating <br />without a permit pursuant to section 34-31-123, C.R.S <br />Signed and dated this ~ day of l9C- lldr , ~. <br />Asphalt Paving Company If Corporation Attest (Seal) <br />ApplicanVOperator or Company Name <br />Signed <br />Title. <br />Signed: ~~~ ~. <br />Corporate Secretary or Equivalent <br />State of (~.(S t~./lA(Y(LD I <br />Town/City/County Clerk <br />o• <br />J~ i . <br />ss. <br />County o <br />The foregoing instrument was ac towledged before [his _~ day of~ ~00.'~ , <br />-, by ~~~ as (~d y~:~/, of <br />t <br />xptlpiAn ends ~~_~aO~ <br />Notary Public <br />~' ~T'~~ My Commission expires 7-a!/~O9 <br />SIGNATURES MUST BE IN BLUE INK <br />M Mm\shore\vs(osms`COnswrnon I @ dx (0'1/r82000) <br />