Laserfiche WebLink
~- <br />Certification: <br />As an authorized representative of [he applicant, I hereby certify that the operation described has met the minimum requirements ofthe <br />following terms and conditions: <br />All necessary approvals from local government have been applied for (Section 34-32.5-110(1)(a)(VIII). <br />2. To [he best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence at the time [his <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.R.S J. (NOTE: For 110 operations, the affected area includes all lands delineated by the permit <br />boundary.) <br />3. No mining operation will be located on lands where such operations are prohibited by law (Section 34-32.5-115(4)(f), <br />C.R.S.). <br />4. As [he applicantloperator, I do no[ have any mining/explora[ion operations in the Slate of Colorado currently in violation of <br />the provisions of the Colorado Land Reclamation Ac[ for the Extraction of Construction Materials (Section 34-32.5-120, C,R.S.). <br />5. I understand [hat statements in the application are being made under penalty ofperjury and [hat false statements made herein <br />are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. 1984. <br />This jorm has been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-IIO,C.R.S., ofthe Colorado Land <br />Reclamation Act for theExtractianofConstructionMaterials. Any alteration ormodificafionofthisfarmsha/lresultinvoidingany <br />permit issued on the altered or modified form and subjecl the operator to cease and desis! orders and civil penalties for operating <br />without a permit pursuant to section 34-32.5-123, C.R.S. <br />Signed and dated this / day of, <br />ZDo ~ <br />Co~ou.~.o Co~~ Com~gr?v L.~ <br />A,p,/p~licaynd-/O/pepray[for /y~ <br />Signed: ~`EP~f/L/ OL L~J~ <br />Title: GP. r1C/a~ t'~d/laar/' <br />State of LD~n ~iA~~ ) <br />ss. <br />Countyof~~AT ) <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me [his !S day of ///~91/ . 1i 491 <br />_, by as ~/f ~eAI /y~.,Z of <br />~~. <br />'~. ~ ~~~. <br />;~ /'i i ~ .~ ,. ~ ti Notary Public <br />b : C .-t 7: / <br />'' ' ~ ~ My Commission expires: CO ' fY - l~ <br />6~ /. ~j <br />''S, rO~•.,, ,. <br />'e,,'-:p~' '~~;3 SIGNATURES MUST BE IN BLUE INK <br />M:\mio\share\vsforms\Constraction110 (Approved OSII ]/2005) <br />