Laserfiche WebLink
<br />Certification: <br />As an authorized representative of the apphcant, I hereby certify that the operation described has met the minimum requirements <br />of 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 34-325-1 l5(4)(e), C.RS.). <br />2. No mining operation will be located on lands where such operations are prohibited by law (Section 34-32.5-1 li(4)(f), <br />C.RS.; <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.RS.) as determined through a Boazd finding. <br />4. I understand that statements in the application are being made under penalty of perjury and that false statements made <br />herein aze punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. <br />Signed and dated this a s day of ` n , r , ~ UCy~ <br />t <br />I~esierrJ ti-lob~~e 5~~~~1,er-n~, T.x, ffCorporationAttest(Seal) <br />Applicant/Operator or Company Name l ' r~Q /~~ <br />Signed: C Signed: ~ / ~/ ~t/ /~ ``~ !/ ~~~. <br />AA Co orate Secretary or Equivalent <br />Title: /t~C~ ~ftivA~.~2 <br />Town/City/County Clerk <br />State of ~~c°-Gr*'/'~t~-~ <br />~7 ,fJ ) ss <br />' County of ~~ /ILO-' ) ~/ <br />The foregoing instrument was acknowledged before me this Or S~ day of , <br />by ~l~L /~~ /J vc-~t~1~. as ~iY~i-L//'L~.#/li o <br />MARGARET F. CASTLEBERRY ~ ~Uif„!1,~7 C1CiJ~~,-r~k._ <br />Notary Public Notary Pu is '~ <br />Slate of Colorado ~ p <br />My Commission expires: % ~ ~ z~~'3 <br />SIGNATURES MUST BE IN BLUE INK <br />