2014-01-22_PERMIT FILE - M2013064 (10)

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Vaffa Companies, Inc. DEC 2 8 2013 Office of Special Projects 8120 Gaize Street Frederick, Colorado 80516 Telephone (303) 666 -6657 Fax (303) 666 -6743 Statement of Understanding Landowner of Adjacent Structure Statement: Our notarized signature below testifies we have been provided with and opportunity to review: 1) a Stability Analysis Report pertaining to the proposed Varra - Coulson Resource Project - Regular Impact (112) Permit Application M- 2013 -064; and, 2) a Map showing the approximate relationship of our property and the potential for any qualified significant, valuable and permanent man -made structure(s), which may occur within 200 feet of lands affected within the proposed Varra- Coulson Resource Project - Regular Impact (112) Permit Application M- 2013 -064. Upon review of the available materials; And understanding the relationship of any significant, valuable and permanent man -made structures under our ownership and which may stand within 200 feet of lands affected within the proposed Varra- Coulson Resource Project - Regular Impact (112) Permit Application M- 2013 -064; Further, by our signatures, as notarized below, we concur that planned activities detailed in the application for permit M- 2013 -064; do not impact our qualified significant, valuable and permanent adjacent man -made structures; and to assure you that in the unlikely event damage occurs to your structures as a direct result of our active operations, it will be compensated for, consistent with established law. %� t Signature of Adjacent Landowner / AV Print Name l State of Ci yy J V ) ss. County of J� ) The foregoing instrument was acknowledged before me this 2013, by Company or Corporation AARON LAWSON NOTARY PUBLIC NOTARY ID 20134000985 ICY CO ?AASSION EXPIRES JANUARY 9, 2017 )/_ 12 _ ,2013 Date 1_�2 day of ��- for - Title —� i'i��%- otary Public My Commission expires: 0 -o - b i F 2