Laserfiche WebLink
-7- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements of the <br />following terms and conditions: <br />All necessary approvals from local government have been applied for (Section 34-32.5-110(1)(a)(VIII). <br />2. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence 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.). (NOTE: For 110 operations, the affected area includes all lands delineated by the permit <br />boundary.) <br />3. No mining operation will be located on lands where such operations are prohibited by law (Section 34-32.5-115(4)(f), <br />C.R.S.). <br />4. As the applicant/operator, I do not have any mining/exploration operations in the State of Colorado currently in violation of <br />the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-120, C.R.S.). <br />5. I understand that statements in the application are being made under penalty of per ury and that false statements made herein <br />are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. 1984. <br />This form has been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-110,CRS., of the Colorado Land <br />Reclamation Actfor 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, CR.S. <br />Signed and dated this // A day of Q"'Iru. > R, l D <br />Co?? o R/Rr?" <br />ylCL c/ S 9_ Q'/ ?/ k- F LL-e- c- aS? A?C ? If Corporation Att (Seal) Cl c ? Y'S <br />plicanUOperator r -C 644 g-F D j htX L <br />a/2, - a5T <br />Signed: nn Signed ?Cr <br />Corporate Sec tary or Equivalen <br />Title: Pte. DGT/f- To ty/County Cler <br />State of <br />JJ. <br />County of "'L 4--C <br />The foregoing instrument w acknowledged before me this day of c?U <br />by of L 1S z _?_ <br />ti r lVC1. <br />Notary Public <br />My Commission expires: 1 o2D - .? <br />SIGNATURES MUST BE IN BLUE INK