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

• Permit No: M2013064
• IBM Index Class Name: Permit File
• Doc Date: 1/22/2014
• Doc Name: Adequacy Review Response
• From: Varra Companies, Inc.
• To: DRMS
• Email Name: PSH
• Media Type: D
• Archive: No

Vaffa Companies, Inc. Nov 1 3 2013
Office of Special Projects
8120 Gage Street Frederick, Colorado 80516 Telephone [phone] Fax [phone]
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.
Signature of Adjacent Landowner
S ��s
Print Name
State of Lo lurad, 0 )
Weld ) ss.
County of )
2013
Date
3U0ITH MORALES
NOTARY PUBLIC
STATE OF COLORADO
NOTARY ID 20034016439
MY CON Ni1SSION EXPIRES JUNE 16 2015
The foregoing instrument was acknowledged before me this ' day of ! o ye &/�� "�"
No
2013, bye Ili�im y/OhA 0.�1G� QVPJG( �/Ul1s ( for
Company or Corporation
Commission expires: (n _ (o -15
2