2006-12-18_REVISION - M1989023 - Laserfiche WebLink

Home Browse Search

Ip'(~LMS ~M-~ I m$ab2~~' REGE~~/Fp ~~: ~r~~e C~~~ ~e . S ~ ~Gc~Ztre ~~ - ~ - DEC 18 2006v Division of Redamilie/f, Certification: Muting and solely As an authorized representative of the applicant, I hereby certify that the operation descnbed has met the minimum requirements of the following terms and conditions: All necessary approvals from local government have been applied for (Section 34-32.5-110{ 1)(a)(VIII). 2. To the best of my knowledge, all significant, valuable and permanent man-made stmcture{s) inexistence at the time this application is filed, and located within 200 feet of the proposed affected area have been identified in this application (Section 34-32.5-115(4)(e), C.R.SJ. (NOTE: For 110 operations, the affected azea includes all lands delineated by the permit boundary.) 3. No mining operafion will be located on lands where such operations aze prohibited by law (Section 34-32.5-115(4xf), C.R.S.). 4. As the applicanUoperator, I do not haveany mining/exploration operations in the Stara of Colorado currency in violation of the provisions of the Colomdo Land Reclamation Act fat the Extraction ofConstruction Materials (Section 34-32.5-120, C.R.S J. 5. I understand that statements in the application are being made underpenaltyofperjuryand that false statements made herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. 1984. This form has been approved by the Mined Land Reclamation Board pursuant to section 34-31.5-IIO,C.RS, ofthe Colorado Land Reclamation Act jar the Extraction afConstruction Materials. Any aheration or modification of this form sha/! result in voiding any permd issued on the ahered or modified form and subject the operator to cease and desist orders and civil penahies jar operating wUhaat a permit pursuant to section 34-~31/.5~113, C.RS Signed and dated this 1~ day of C/~-fro„-,~o~t_~ . olrD o(~,~ Clyde and Marie Couch '// ApplicanUOperator/,~{7~~/q ~//~ Signe~/~,/~~ / t ~, / / /~!/W~ aC'~~ Title' owner State of ~~~ Z~~~ 1 Town/City/County Clerk ss. Counryof ~A~~~P~ ) The foregoing instttrment was acknowledged before me this ~ day of <~L~f3L'.~. , u-~ , b Clyde Couch /ylfl'2l~ ~OlJ~ff y ~' as -------------------------------- of RICHARD RUTHERFORD Notary Public -Arizona Maricopa Courtly My Commission Expires July 20, 2009 ~! / ~. Notary Public My Commission expires: V UT. 2~9 If Corporation Attest (Seal) Signed: Corporate Secretary or Equivalent SIGNATURES MUST BE IN BLUE INK M:\min\sham\vstom,s\ConstruMianl 10 (Approved 05/11/2005)