Laserfiche WebLink
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 p day of /TUq 115/ <br />GU' coL- <br />(ri i S Zne . <br />Applicant/Operator or Comp ame <br />Signed: <br />Title: President <br />- 8 - <br />State of e0 i91-040 ) <br />County V1J�2I ) )s. <br />Coun of �� <br />The foregoin instrument was acknowledged before m this cg 1 - 4 day of <br />c90// d // , by (r 5 i x i- • 1'c_ as C'S i v/ " e.,. 7 <br />ao// <br />If Corporation Attest (Sea , • <br />Signed: <br />Co . •rate Sec 3'. or Equivalent <br />Town/City /County Clerk <br />of V of Von <br />Notary Public <br />/ My Commission expires: /!7.3 / `� a t ":. <br />SIGNATURES MUST BE IN BLUE INK e <br />You must post sufficient Notices at the location of the proposed mine site to clearly identify the site as the,location-_oo:a <br />