Laserfiche WebLink
<br /> <br />Certification: <br />As an authorized representative of the applicant. I hereby certi tj that the operation described has met the minimum requirements <br />of the tullosving terms and conditions: <br />1. To the best of my knowledge, a] I sign iticant. valuable and permanent man-made structure(s) in existence at the time <br />this application is tiled. and located within 200 feet of the proposed affected area have been identified in this application <br />(Section 34-32.5-1 1 5(4)(e). C.R.S.). <br />2. No mining operation will I-w located on lands where such operations are prohibited by law <br />(Section 34-32.5-1 15(4)(t), 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. l understand that statements in the application are being made under penalty of'penury and that false statements <br />made herein are punishable as a Class I misdemeanor pursuant to Section 18-8-503, C.R.S. <br />This form has been approved hr the ,tined Land Reclamation Board pursuant to section 34-32.5-1140. R.S., of the Colorado Land <br />Reclamation . tct fur the 1:7.wraction of C'oastruetion ,F/aterirtl.c. Ann alteration or modification of Nos form shall result in voiding any <br />permit issued on the altered or modified form and.subject the operator to cea se and desist orders- and civil penalties for operating <br />without a perlnit purvitant to section 34-32.5-123, C.R" S. <br />'*ncd and dated this _ day of - <br /> <br />[?? I <br />AF <br /> <br />-__ C t <br />?N o-?:4 R4V?t'_ C (?VDL, k-T5 kAIC. IfC'orporation Attest (Seal) <br />Applicant/Operator or Company Name <br />Signcd: _ _ qwa?-Clj---d Signed: <br />-- - -- - - <br /> Corporate Secretary or Equivalent <br />Title: l ?? ?- - _--- - - Tov n City 'Coumy Clerk <br />S <br />t <br />f <br />c el <br />ta <br /> <br /> <br />03 <br />nk <br />el { ?t ?CS? ?P <br />?? <<e1a _ <br />Lyre <br />t C ' S Gt aLeA 4 <br />roo iS <br />, <br />.? t . <br />. <br />> <br /> r <br /> A, <br /> <br />E <br />BETH MCtAUGKIN <br />Notary Pubft Ntary-N Public <br />State of Colorado <br />O ? <br />7ol <br />( <br />tit <br />' <br />' <br />' <br /> UfT1TTlttitil?)n CCp1I <br />CS <br />! <br />p <br />pL <br />\ <br />l.f? <br />0 111(;\:11I RI-` Nil tit of IN 131-I F INK