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 mods fed form and subject the operator to cease and desist orders and civil penalties for operating <br />without a permit pursuant to section 34-32.S-123, C.RS. <br />Signed and dated this day of `l _e_ t <br />_ • 1??-?--• ` = " `,.--..,-- , , :' ? %; <br />Z &k ` If Corporation Attest (Seal <br />Applicant/Operator or Company Nam y ? y <br />Signed Sig <br />• Town/City/County Clerk <br />Title: ??? <br />State of 0 l atr j'a 1 <br />/? ) ss. <br />County of l T l?-lal 1 <br />Y- <br />The foregoing instrument was acknowledged before me this IS day of S 6 ? Le <br />W by Al.-Yo e i?P (i. 1 P VT 4- as V. Pv e-5 4- 5 eo- rof W1t34. %4--0.ipruc C 6i!C? ? T' e <br />O,?pp?l,?` r. (jC?-6?2tsz?..? ? C?.e•zoL <br />Notary Public <br />:CATHERINE S.' 0 <br />ACORD ' My Commission expires: <br />Nq : P44 <br />?F OF SIGNATURES MUST BE IN BLUE INK <br />CA-4019 st sufficient Notices at the location, of the proposed mine site to clearly identify the site as the location of a <br />icr- <br />Rej)ised on 9%',L6+ It, 9610 <br />n;oirporate Secre or Equivalent