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 perjury 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, C.R.S., of the Colorado Land <br />Reclamation Actfor the Extraction of Construction Materials Any alteration or modification of this fora: shall result in voiding any <br />permit issued on the altered or modified forms and subject the operator to cease and desist orders and civil penalties for operating <br />without a pertnitpursuant to section 34-32.5-123, C. S. <br />Signed and dated this day of <br />Applicant/Operator <br />Signed: J w <br />If Corporation Attest (Seal) <br />Signed: <br />Title: <br />C OLDQ?-D D <br />State of C D L D4 ) <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />County of ) r 7 ; ??_?pMf6?_ D-0 ` Q <br />The foregoing instrument was acknowledged before me this ?X' t F day of WLEmC -it _ 0010 <br />by \\ N" J H Z bSS as 0 1*\J of <br />J EYQ? 0 5 44 Zp Ss C) W N)J? - <br />Notary Public <br />; <br />... My Commission expires: t l ? ?l <br />®®° ®© e? T <br />® MEGAN SIGNATURES MUST BE IN BLUE INK <br />TOMASK g <br />° <br />OF <br />c??