Laserfiche WebLink
RECEIVED <br /> qO <br /> ,N JUN 10 2021 <br /> -8 - <br /> DIVISION OF RECLAMATION <br /> Certification: MINING&SAFETY <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 open.tin <br /> without a permitpursuant to section 34-32.5-123, C.R.S. t!�uu> JoiJ� <br /> Signed and dated this day of �V ,Zo�— <br /> SEAL <br /> If Corporation Attest(Seal) <br /> Applicant/ for or Company Name <br /> �JU/J1Np1NIM111\\�\\ <br /> Sign Signed: r <br /> Corporate Secretary or Equivalent <br /> Title: 0�, //�i�i`�j �Of�' Town/City/County Clerk <br /> State of Co of-(&&Q ) <br /> )ss. <br /> County of <br /> The foregoing instrument was acknowledged before me this V day of <br /> aQ \,by �b C1�C� ��(',.c r as "� V� of G. Calk n E�L-) <br /> NANCY L WR18 <br /> NOTARY PUKJC r <br /> STATE OF COLORADO Notary Public <br /> NOTARY ID 199MI9442 <br /> MY COMMISSION EXPIRES APRIL 1,20Q2 <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 />