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 />Signed: <br />Title: <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 15 ' day of Febr ii-ar AO . <br />W041 Sewer ,Itt4 o <br />t* <br />.i� <br />Appli erator or Comp PP P Pte Name ' <br />. 1 '. / 1:1 <br />State of Colorado <br />) ss. <br />County of Weld ) <br />The foregoing instrument was acknowledged <br />Zia, by .TCN\ inr)f\Dfl <br />- 8 - <br />on Attest (Seal) <br />rporate S tary or Equivalent <br />Town /City /County Clerk <br />before me this / 5 day of ebr . / . .k. <br />as LA)24P• (11111 SQSWer r LLor of +. <br />1 1 /1L► <br />al Public <br />My Commission expires: 021,24/208 <br />You must post sufficient Notices at the location of ":�..;• e site to clearly identify the site as the location of a <br />