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Varra Companies, Inc. <br /> Office of Special Projects <br /> 8120 Gage Street Frederick,Colorado 80516 Telephone(303)666-6657 Fax1303)666-6743 <br /> Statement of Understanding <br /> Landowner of Adjacent Structure Statement: Our notarized signature below testifies we <br /> have been provided with and opportunity to review: <br /> 1) a Stability Analysis Report pertaining to the proposed Parcel 122 Resource Development <br /> Project-Regular Impact(112)Permit Application M 2015 033;and, <br /> 2) a Map showing the approximate relationship of our property and the potential for any <br /> qualified significant, valuable and permanent man-made structure(s), which may occur <br /> within 200 feet of lands affected within the proposed Parcel 122 Rc,,ouree Development Project-- <br /> Regular Impact(112)Permit Application \12015 013. <br /> Upon review of the available materials; <br /> And understanding the relationship of any significant, valuable and permanent man-made structures <br /> under our ownership and which may stand within 200 feet of lands affected within the proposed Pa rc e l 122 <br /> - Resource Development Project -Regular Impact(112)Permit Application \l 2015 033; <br /> Further, by our signatures, as notarized below, we concur that planned activities detailed in the <br /> application for permit M -2015-033; do not impact our qualified significant, valuable and permanent <br /> adjacent man-made structures; and to assure you that in the unlikely event damage occurs to your <br /> structures as a direct result of our active operations, it will be compensated for, consistent with <br /> established law. <br /> 5V/er? ,2015 <br /> Signature of Adjacent Landowner Date <br /> �JS� jI / v'" <br /> Print Name <br /> State of ( ( Ir ) <br /> ./ ) ss. <br /> County of `�t . '(et ) <br /> The foregoing instrument was acknowledged before me this /43. day of �'de])I 2015, <br /> }y . G1/l. ,4t/i. A � ( 1�t�f�� tinturv�an: for i ��� wd /�. ,c <br /> ([•hathRt �.L. L� tri. t ). Title <br /> ;jompany or Corporation <br /> Ktailt2 - (7)1/2 ? ,Gt,; <br /> ROXANNE GARCIA Notary Pine <br /> NOTARY PUBLIC <br /> STATE OF COLORADO My Commission expires: 5-2-2(V/ <br /> NOTARY ID 19974001261 2 <br /> MY COMMISSION EXPIRES MAY 2,2017 <br />