2015-09-29_HYDROLOGY - M2015033

• Permit No: M2015033
• IBM Index Class Name: HYDROLOGY
• Doc Date: 9/29/2015
• Doc Name: Resource Development Project
• From: DRMS
• To: Peter S. Hays
• Email Name: PSH
• Media Type: D
• Archive: No

Varna Companies, Inc.
Office of Special Projects
8120 Gaee 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 Parcel 122 - Resource Dc\'elopmcnt
Project - Regular Impact (112) Permit Application M-2015-033; 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 Parcel 122 Rc�ource Dc\ clopmcnt Project —
Regular Impact (112) Permit Application N 1 2015- 033.
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 Parccl 122
- Resource Dei elopmcut Project - Regular Impact (112) Permit Application M-2017-033;
Further, by our signatures, as notarized belmti', we concur that planned activities detailed in the
application for permit �1-2015-033; 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
Print Name
State of
ss
County of
5�
The foregoing instrument was acknowledged before me this _ day of
by ( for
1. Title
Company or Corporation
Notary Public
12015,
My Commission expires:
2