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OCT o 9 205 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 P_.r,el 122 - Resource Development <br /> Proicct-Regular Impact(112) Permit Application \i 2''1 i 031;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 :_ Prt ljc ct - <br /> Regular Impact(112)Permit Application \I :CI 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 I':u-cdl 122 <br /> c lohmoit 1'roj i t-Regular Impact(112)Permit Application \12015 0 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 result of our active operations, it will be compensated for, consistent with <br /> established law. <br /> •-V- - ,2015 <br /> Signature of Adjacent Landowner Date <br /> Print Name <br /> � Ry <br /> a° o <br /> State of tot 0/A--,1 ) PUB�-�C' . <br /> : Q. <br /> )ss. `Pi, • . <br /> County of �c��r�►rc ) �'�i,IF OF C°, <br /> `‘ <br /> The foregoing instrument was acknowledged before me this 614day of a.1+%4 c P ''Ol <br /> by L t v-\ for AA,.,•%'e,- , <br /> LJctfi'c� )- Title <br /> Company or Corporation <br /> o : Public <br /> My Commission expires: 3/2.:3/iv' <br /> 2 <br />