Laserfiche WebLink
-8- <br />Certification: <br />As an authorized representative of the applicant, l hereby certify that the operation described has met the minimum requirements of <br />the following terms and conditions: <br />1. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) inexistence at the time this <br />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.RS.; <br />3. As the apphcant/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 fording. <br />4. 1 understand that statements in the application are being made under penalty of perjury and that false statements made <br />herein are punishable as a Class I misdemeanor pursuant to Section 18-8-503, C.R.S. <br />This form has been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-112,C.RS, of the Colorado Land <br />Reclamation Ad for the Extraction of Construction Materialx Any afteration or modification of this form shall result in voi&q any <br />permitissued on the altered or mofifredform andsub%edthe operator to cease anddeshtorders andaivilpena1fies for urg>.idlrout <br />a permit pursuant to section 34-32.3-123, CRS <br />Signed and dated this 13 iA day of f'e /U <br />-11 VGM2?, LY\aC:& 65,77& <br />Applicant/Operator ar Com Name <br />Signed: <br />Title: esj (1en+ <br />State of 0-,0102?Q ) <br />County of (1 )SS. <br />) <br />y V -e ( <br />The foregoing instrument was acknowledged 1 <br />by ?hs? ?x !.. A as <br /> <br />If Corporation Attest (Seal) <br />c <br />Signed. <br />Co rate Secretary or Equivalent <br />Town/City/County Clerk <br />SIGNATURES MUST BE IN BLUE INK <br />M'VWnW=Nvdww\Comwction 112.doc (Approved 05/11/2005) <br />My Commission expires: O / /