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Varra Companies, Inc. <br /> Office of Special Projects <br /> 8120 Gage Street Frederick,Colorado 80516 Telephone(303)666-6657 Fax(303)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 /> ('R-1k:et-Regular Impact(112)Permit Application NI 2015 0»;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 • - [, - t ['noj L c t - <br /> Regular Impact(112)Permit Application%; 5 33. <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 ('.l rc el 1-)2 <br /> (:� �n.n e� I pct i It'pmenr ('r j.k t-Regular Impact(112)Permit Application Ni 2015 0 3>; <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 /> stru'tures as a direct result of our active operations, it will be compensated for, consistent with <br /> es :Wished 1: . <br /> ....A 7— l7 :101 5 <br /> .igna r re of Adja'ent Landowner Date <br /> 61' l <br /> Print Nam: <br /> State of COLO Cod O <br /> d ) ss. <br /> County of ) <br /> The for foreigoing instrument was acknowledged beforeAne this i7day of S ,2015, <br /> by N ( e5ide for P NIX Prod(..C�. <br /> ). Title <br /> Company or Corporation <br /> JESSICA HOOVER ` <br /> NOTARY PUBLIC N. , Public <br /> STATE OF COLORADO <br /> NOTARY ID 20044035571 <br /> My Commission Expires Oct.4, 2016 My Commission expires: dN'i 40 <br /> 2 <br />