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Varra Companies, Inc. OCT 2 6 2015 <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 P=Ercel 122 Resource Development <br /> Pro)ect-Regular Impact(112)Permit Application NI 2015 0'.,3;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 ='.1 ,1 I i.-',_. < _ 1,_r-!:1_n t ('roe j�<t - <br /> Regular Impact(112)Permit Application \t 2015 0;3. <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 I'.trLd 122 <br /> — Re-oil rer [lry rlopmcnt t'mjcct—Regular Impact(112)Permit Application \12015 t)33; <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 rest of our active operations, it will be compensated for, consistent with <br /> estab ' fhed Ove c e ar amu.«-4 w,71 tie Se /61,1 .w i--^e- <br /> Old'Z3 ,2015 <br /> Si attire of Adjacent Landowner Date <br /> ,� 6. Fly Q Svsa <br /> Print Name <br /> State of ( (QZ11.\- ) ) <br /> ) ss. <br /> County of U ) <br /> The foregoing instrument was acknowledged before me this day ofl it [fi e. - ,2015, <br /> by 1-LPO ( Ytibit i=(12 for ,moi, \r'P fAD <br /> �00j i iNsr-/c`)p -, ). Title <br /> Company or Corporation .,_eL z `,k, _ <br /> -- istA14.4.ii, liktiO <br /> -41-' : Af,ON,* 4 , <br /> Notary Publi& <br /> f'' p081.-\G `c► <br /> ",:f 'F 0,:i My Commission expires: b 1 l-I J c) <br /> 2 <br />