PERMFILE110490

• Permit No: M2001019
• IBM Index Class Name: Permit File
• Doc Date: 3/14/2001
• Doc Name: CONSTRUCTION MATERIALS REGULAR 112 OPERATION RECLAMATION PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

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Certification:
Signed:
As an authorized represrntative of the applicant, l hereby certify that the operation described has met the minimum requirements
of the following terms and conditions:
1. To the best of my Imowledge, all significant, valuable and permanrnt man-made structure(s) m existence at the time this
application is filed, and located within 200 feet of the proposed affected azea have been identified in this application
(Section 34-32.5-1 l~(4)(e), C.RS.).
2. No mining operation will be located on lands where such operations are prohibited by law (Section 34-325- l li(4)(f),
C.RS.;
3. As the applicant/operator, I do not have any extraction exploration operations is the State of Colorado currently in
violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials (Section
34-32.5-120, C.RS.) as determined through a Boazd 5nding.
4. I understand that statemrnu in the application are being made under penalty of perjury and thaz false statements made
herein aze punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS.
Signed and dated this .~ ° " day of ila art. ~ ii ~~'
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Applicant/ rotor or Company Name
Signed: ,! .
Title: n. ~~,~,
State of
County of
ss
The foregoing instrument was aclmowledged before me this
by
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If Corporation Attest (Seal)
Corporate Secretary or Equivalent
Town/City/County Clerk
day of ,
of
Notary Public
My Commission expires:
SIGNATURES MUST BE IN BLUE INK