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,CRS, 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, CRS <br />Signed and dated this c3.4 day of N b<< , t9e.)t <br />Signed <br />Title: Road Supervisor <br />- 8 - <br />} <br />Signed: <br />Corporate Secretary or uivalent <br />Town/City <br />State of NA f)R ) <br />) ss. <br />County of 16141..S k <br />The foregoing instrument was acknowledged before me this i S day of 11 & ►tit<- v d �1 <br />02, by _ A-' f i -(oek-q r iA as r)ft;� �i 1��1�scY� of `�U �i Il7C�Tr��t� l D.)A <br />VALERIA JEAN FOUTI <br />NOTARY PUDIC - STATE OF COLORADO <br />Notary Identification #20084021150 <br />My Commission Expires 6/17/2016 <br />My Commission expires: <br />SIGNATURES MUST BE IN BLUE INK <br />You must post sufficient Notices at the location of the proposed mine site to clearly identify the site as the location of a <br />