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

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Var r a Companies, Inc. Offiice of Special Projects 8120 (laec Street Frederick, Colorado 80516 -felehhone (303) 060 -6057_ 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: I) a Stability Analysis Report pertaining to the proposccl V.11ra- Cmilson Resource Project - IZCgUlfll' Impact (112) Pcrmit 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 V,11'111- COUIS011 RCSOtlree Project Regular Impact (112) Pcrmit 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 fect of lands affected within the proposed Varra- Coulson RCSOLINC 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. Signatu -c ol' Adjacent Landowner :3 \-Vamp "J t rA Print Name State of C,o�o�� cJ ) County of �t�.�� \(� _ ) ,20 13 Date 4 The forcgoin 7 ii titrumcnt Vas acknowledged before me this /— clay of u ejl- _ for' 'I'itic Company or Corporation Notary Public - my (:rnnmission expires: /O TERESA MALLOY Notary Public State of Colorado