Laserfiche WebLink
-8- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum <br />requirements of 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 <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 Recla.? ation 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 Board pursuant 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 permitpursuant to section 34-32.5-123;, C.R.S. <br /> <br />Signed and dated this day of i1- 0M -Gt, &uA f)1 G <br />f=mh K Le_ov , , -:Sy- _ ,R ??tovt;. , WfPh" IVA-H?_- <br />lieb?ne?, 5OIYNL44 a-fave'l LLQ1, 0NL`( If rporat?V)tte (Seal) <br />Applicant/Operator or Company Name <br />Signed: •??-??`? <br />Title: /A A Al 11 C? r' <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br /> <br />State of ?0 10r<'vo ) <br /> <br />County of ff td. ) ss. <br />1144"1)105 ) <br /> <br />F>R LEa2v 'A' 0 "Al 7.J&, 600, ",VA/f- SAW ? 6AA& <br />The foregoing instrument was ackno 9d before me this day of <br />? vu <br />by it 10 as of c `U %C3dad,ca <br /> ti=?N f-,R,'y n/Ay-l? ?i?GN t'S Tsr? PAN Y NAH9- <br /> <br />Notary Public <br />My Commission expires: <br />SIGNATURES MUST BE IN BLUE INK <br />You musty post sufficient Notices at the location of the proposed mine site to clearly identify the site as the location of a