Laserfiche WebLink
0611712009 02:24 <br />G erti.ficatkn: <br />9702475104 <br />DMG DURANGO OFFICE <br />-S- <br />PAGE 11/13 <br />As an authorized representative ofthe applicant, I hereby certify that the operation described has met the minimum requirentems <br />of the following terms and conditions: <br />1. To the best of my knowledge, all significant, valuable and permanent man-made Structure(s) hi 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), CRS.; <br />3. As the applicant/operator, I do not have any extraction/exploration operati.ors it The State- of Colorado c„**r*atl;? i^ <br />violation. of thy: 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 trade under penalty of perjury and. that false statements <br />made herein are punishable as a Class 1, misdemeanor pursuant to Section. 1.8-8-503, C_R.S. <br />This fortrr has been approved by Ike Mitred Land Reclatrratiorr ,Board pursuant to seealon 34-32.5-112,C-A& of fire Colorado Land <br />Reclamation Actor the,tWractlort of Construction Materials. Any aPere ion or modification of this farm shallresult irr 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 permitpursuant to seEdon 34-32.5 123, C,R,S <br />Signed and dated this, day of <br />Applicant/Operator or Company Name <br /> <br />Title: <br />-c-,_ <br />State of. <br />ss. <br />County ot`.'Y...... <br />( __.. ) <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Fquiva lent <br />Town/City/County Clerk <br />The foregoing instrument was actmowledged before !P,Rday of by ?J..?1?.?._?..?.??_?i!'_a-_ a'S <br />r .. ".rt! ___of S X47 M4' <br />Nota.ryfublic l ! <br />M.y Commission expires: <br />.__. <br />"SIGNA'TtJR.E4'M;US'T HE IN 13.i.AM INK