2008-04-10_PERMIT FILE - M2008017

• Permit No: M2008017
• IBM Index Class Name: PERMIT FILE
• Doc Date: 4/10/2008
• Doc Name: Incompleteness Notice
• From: DRMS
• To: Broken Arrow Investments, LLC
• Media Type: D
• Archive: No

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Certlfica~lon:
As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements
of the following terms and conditions:
L. To the best of my knowledge, all significant, valuable and permanent man-made structures} in existence at the time
this application is filed, and located within 200 feet of the proposed affected area have been identified in this application
(Section 34-32.5-i 15(4)(e}, C.R.S.).
2. No Honing operation will be located on lands where such operations are prohibited by law
(Section 34-32.5-115(4}(f), C.R.S.;
3. As the applicant/operator, I do not have any extractioniexploration operations in the State of Colorado currently in
vioEation of the proL'isions of the Colorado Land Reclamation Act for the Extraction of Construction Materials
(Section 34-32.5-120, C.R.S.) as determined through a Board finding.
4. I understand that statements in the application are being made under penalty of perjury and that false statements
made herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S.
This form has been approved by the ~Klned Land .Reclamation Board pursuant to section 34-32.5-112,C.R.~, of the Colorado Land
Reclamation Act for the Extraction of Construction hlaferials. Any alteration or modification ojthis form shag result an voiding any
permit issued on the altered or modified form and subject the operator to cease and desalt orders and civil penalties for operating
without a permit pursuant to sQectaon 34-32.5-I13, CR~.gS.
Signed and dated this t day of ~/~ ~ ~0~~
dro kin ~ rr~c~ ~u~sm~n~', ~ ~.~.
Applicant/Operator or Company Name
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Sinned: ~r~t--
_yY i22~c~-"
Title: ~~
State of _~ ~~~' o~c~-~ ___--_-___-- }
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If Corporation Attest (Seal)
Signed:
Corporate Secretary or Equivalent
Tow~v'City/County C3erk
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The foregoing instrument was aalrnawledged befc:re me this -._~._._-___---_ day of __W~~~ ~--,.__._...,W......__.__-.__.______.,
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Notary Public
?Vty Commission expires: _~b~,_ ~ ~. ~ X1.0--
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