Laserfiche WebLink
-8- <br />Certification: <br />As an authorized representative of the applicant, 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 <br />this 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.). <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.R.S.; <br />3. As the applicant/operator, 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 <br />(Section 34-32.5-120, C.R.S.) as determined through a Board finding. <br />4. I understand that statements in the application are being made under penalty of perjury and that false statements <br />made herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. <br />This form has been approved by the Mined Land Reclamation Boardpursuant to section 34-32.5-112,C.R.S., of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials Any alteration or modification of this form shall result in voiding any <br />permit issued on the altered or modified form and subject the operator to cease and desist 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 9t??- <br />Moffat County Board of County Commissioners if Corporation Attest (Seal) <br />Applicant/Operat or Company Name <br />?F.p'T• C041 <br />% <br />igiied.: • ;.?. igt?ed: <br />Corporate Secretary or Equivalent <br />Title Town/City/County Clerk <br />Los <br />State of } <br />)Ss. <br />County of ) <br />The foregoing instrument was acknowledged before me this Y day of <br />O?g?ct by as <br />C?i7 ?rn / J d C c?13 J <br />- 3?_ ?of <br />-b otary Public <br />My Commission expires: <br />SIGNATURES MUST BE IN BLUE IN