Laserfiche WebLink
-~- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements of the <br />following terms and conditions: <br />All necessary approvals from local government have been applied for (Section 34-32.5-1 IO(1)(a)(VIII). <br />2. 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 [his application <br />(Section 34-32.5-115(4xe), 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-I IS(4)(f), <br />C.R.SJ. <br />4. As the applicanUoperator, I do no[have any mining/explorntion operntions in the Slate of Colorndo currently in violation of <br />the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-12Q C.R.S J. <br />5. I understand that statements in the appliption are being made under penalty ofperjury and that false statements made herein <br />are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. 1984. <br />This form has been approved by the filmed Land Reclamation Board pursuant to section 3442.5-IIO,C.RS., ojthe Colorado Land <br />Rer/ama~ionAdjortheF.xYracfionojConstructianMateriats Angdterationormodificationojthrsjarmshdlresu/t in voiding any <br />permit issued on the altered or modifred form and subject the operator W cease and desist orders and civilpenakies jor operating <br />without a permit pursuant to section 34-325-123, C.RS <br />._cs_ ~ as <br />Signed and dated this ~ day of '~ <br />CoN % /N EN7/} L~) bl~~t r(Qr1 ~ , LLC. <br />ApplicanUOperntor <br />Signed: -~ ~ C- ~ V'~ <br />'n t1 <br />Title((:~~y/~~/t5/J)£NT 4YuY/<~n5o!1~/lrlt %loperTr<5/tJI~IJC i <br />//10.r~0.4G/ b~nW1'fl ~^er~~1~~/ LL '\ <br />State of~rJn~01'~<X-~ ) <br />ss. <br />County of La ~~ G ) <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instmment was acknowledged before me this l ~ day of J k ( , <br />_, by ~or\ t`Z I~u;; ~ ~~ as t~-r<6. of hush r~ Alo'rtC I"{14t Zn~ of <br />~ f,~ ~ / <br />~nAa 0 ''W'"`uX -bVi KQ~/ LLL. <br />My <br />SIGNATURES MUST BE IN BLUE INK <br />If Corporation Attest (Seal) <br />Signed: <br />expires: <br />aptARY <br />PIIB~-~~ <br />M:Unin\sham\vsforms\Coostruc[ionl t0 (Approved OS/1 (/2005) <br />