Laserfiche WebLink
-~- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation describedhas met the minimum requirements of <br />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 area 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 <br />(Section 34-32.5-115(4)(f), C.RS.; <br />3. As the applicant/operator, I do not have a~ 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 34-32.5-120, C.RSJ as determined through a Board finding. <br />4. I understand that statements in the application are being made under penahy of perjury and that false statements made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. <br />This form kas been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-112,C.RS., ojrke Colorado Land <br />Reckunation Act jor tke Extraction of Construction Materials. Any akerotion or modification of this form skaII resuk in voiding any <br />permit issued on tke a@ered or modified form and subjectthe operator to cease and desistorders and cmilpenaltiesjor operatingwithout <br />a permit pursuant to section 34--32-123, GRS <br />Signed and dated this /,2 t/~ day of _, .4~/~~1~ ~C~Sr <br />eNs"fir/ (Jr v f/~ ~ r' S <br />ApplicanUOperator or Company T <br />-~~ <br />Signed:. r <br />Tide: ~~ ~c'tiL_~-s~p/1 <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of Lo ~o ~~sr9l d ) <br />ss. <br />County of Da~fQ ) <br />+>, <br />The foregoing instrument was acknowledged before me this ~ ~ - day of c J(: n kc~ r" . ~~, by <br />f C`~c~~az~ccl. p~t,ist~~as ~Lyif~2.~.~ of c~.eA/5~~ Yb ~~-QY'S <br />n i~utl~~lll/ <br />l/w ~~ ltl~ Q. 43eit soft ~,EtA,H,q~~,,, ~ ~ n t~ <br />.. Q. ... • cr`~x <br />~00TARy~~s Notary Public <br />-4--0~- <br />_ o;;.!°U B L~G~~ g My Commission expires: I ~ I ~ bI a~C1`~ <br />BE IN BLUE INK <br />M:~mmlchareW4o(mc~cooshucrtw t~Z.ax (orrzarzooa7 <br />