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An example Structure Agreement which meets the requirements of the Statutes is shown below. <br />Structure Agreement otqisi00 of 5la �y on� <br />W,6",g <br />This letter has been provided to you as the owner of 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 significant, <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 6.3.12 and Rule 64.19 & 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 farm, if <br />properly executed, represents at? agreement that complies with Construction Materials Rule 6.3.12(a), <br />Rule 6 4.19(a), and C.R.S. § 34-32.3-115(4)(e) and with Hard Rock/Metal Mining Rule 63.12(a), Rule <br />6 4.20(a), and C. R. S. § 34-32-113(4)((). This form is for the sole purpose of ensuring 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 anv egforcement 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 />2. <br />3. <br />4. N )pr <br />s. N Ih- <br />(Please list additional structures on a separate page) <br />