Laserfiche WebLink
�v ►� A-y_ <br />t_ser s s <br />cj <br />� U c, \J 1� i S -- (Z b N Al <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 />1. 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 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 3rd day of February, 2012 <br />Cooley & Sons Excavating, Inc. <br />Applicant /Operator <br />Signed: <br />Title: <br />President <br />State of ) <br />ss. <br />County of ) <br />The foregoing instrument was acknowledged before me this 3 day of <br />by ���' as <br />V <br />-7- <br />l ECE WEO <br />FEB 3 232 <br />DURANGO FIELD OFFICE <br />DIVISION OF RECLAMATION, <br />MINING AND SAFETY <br />If Corporation Attest (Seal) <br />Signed: <br />SIGNATURES MUST BE IN BLUE INK <br />Corporate Secretary or Equivalen <br />Town /City /County Clerk <br />'}V J (f(AtJ <br />Notary Public <br />My Commission expires: < 3 /cZA 7 <br />