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) 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 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 permit pursuant to section 34-32.5-123, C.R.S. <br />Signed and dated this day of (? <br />?l_ <br />r? <br />If Corporation Attest (Seal: <br />Applicant/Operator or Comp Name <br />Signed: Signed: <br />Corporate Secretary or Equivalent <br />Title: Town/City/County Clerk <br />State of (J n I p ra A b ) <br />ss. <br />County of G )L-Q h t ) <br />The foregoing <br />was.acknowlled ed before me this day of 1 I <br />, as Ili.a Pte s ide of <br /> <br /> <br />:CATHERINE S <br />ACORD <br />?rE .?0! <br />QF C?t <br />0'11idl?xi ,d'.? <br />Notary Public <br />My Commission expires: Q <br />?], SIGNATURES MUST BE IN BLUE INK <br />My Commu-sion E0es4(1L <br />You must post sufficient Notices at the location of the proposed mine site to clearly identify the site as the location of a