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An example Structure Agreement which meets the requirements of the Statutes is shown below. <br /> #*****#*i***tit***************3***************#*********8********#************m**** <br /> Structure Agreement <br /> This letter has been provided to you as the owner of a structure on or within two hundred(200) <br /> feet of a proposed mine site.The State of Colorado,Division of Reclamation,Mining and Safety <br /> ("Division")requires that where a mining operation will adversely affect the stability of any cignificant, <br /> valuable and permanent man-made structure located within two hundred(200)feet of the affected land, <br /> the Applicant shall either. <br /> a) Provide a notarized agreement between the Applicant and the Person(s)having an interest in the <br /> structure,that the Applicant is to provide compensation for any damage to the structure;or <br /> b) Where such an agreement cannot be reached,the Applicant shall provide an appropriate <br /> engineering evaluation that demonstrates that such structure shall not be damaged by activities <br /> occurring at the mining operation;or <br /> c) Where such structure is a utility,the Applicant may supply a notarized letter,on utility letterhead, <br /> from the owner(s)of the utility that the mining and reclamation activities,as proposed,will have <br /> "no negative effect"on their utility.(Construction Materials Rule 63.12 and Rule 6.4.19&Hard <br /> Rock/Metal Mining Rule 6.3.12 and Rule 6.4.20) <br /> The Colorado Mined Land Reclamation Board("Board")has determined that this form,if <br /> properly executed represents an agreement that complies with Construction Materials Rule 6.3.12(a), <br /> Rule 6.4.19(a),and C.R.S.§34-32.S-115(4)(e)and with Hard Rock/Metal Mining Rule 6.3.12(a),Rule <br /> 64.20(a),and C.R.S.§34-32-115(4)(d). This form is for the sole purpose of ensu ing compliance with the <br /> Rules and Regulations and shall not make the Board or Division a necessary party to any private civil <br /> lawsuit to enforce the terms of the agreement or create any enforcement obligations in the Board or the <br /> Division_ <br /> The following structures are located on or within 200 feet of the proposed affected area: <br /> 1. Buildings on State Highway Property <br /> 2. dirt road to Gold King Mountain Inn <br /> 3+ paved road City of Cripple Creeks <br /> dirt road DeeAnne McGenrus <br /> 4. C as/ / us ya <br /> 5 power lines Black Hips Energy 6.(let road John Schafer <br /> (Please list additional structures on a separate page) <br /> NOTARY FOR STRUCTURE OWNER <br /> ACKNOWLEGED BY: <br /> C <br /> Structure Owner n K. J�b gq� e* ' / <br /> k � / -- <br /> Date ,3 8T/ Title LI 4.1%-` 411111° - <br /> 374 Oscar Arvizu <br /> STATE OF. hiNY1l4 ) Notary Pu <br /> • <br /> ss. Pima County, zona <br /> COUNTY OF Q(in ) �,,r+� My Comm.Expires 03-20-2021 <br /> • <br /> The foregoing was acknowledged before me this.- day of Wilk 20 b <br /> 6h 1 Sr .a 4►( as ria 1� of 1741tr '�o r5 U-C <br /> 404 / My Commission Expires: 03 )A <br /> eg Public <br />