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Structure A6reenient <br /> This letter has been provided to you as the owner of a structure on or , itliin n o liundred(_,CtCt t <br /> feet of a proposed none site. The State of Colorado. Division of Reclamation. Mining and Safety <br /> �--Division*')regxinY+that a-licre a mining operation ill adversely affect the Stability of any Srgrlifrcailt. <br /> valuable and permanent man-made stricture located\vlthin ttvo hundred(00)feet of the affected land. <br /> the Applicant shall either: <br /> a) Provide a notarized agreement bets,-,-een the Applicant and the Person(s)having an interest in the <br /> stricture.that the Applicant is to provide compensation for any damage to the structure:or <br /> b) Where such an a_reenient cannot be reached.the Applicant shall provide all appropriate <br /> engineering evaluation that demonstrates that such structure shall not be damaged by activities <br /> occurring at the nuninc,operation: or <br /> c) Where such structure is a utility. the Applicant may supply a Notarized letter,oil utility letterhead. <br /> fi•om.the owner(s)of rice utility that the ruining and reclamation activities. as proposed.Nvill have <br /> ..no negative effect"on their utility. ( Conswuction Materials Rude 63.12 and Rule 6.4.19&Hard <br /> RocklMetal Mining Rule 6.3.12 and Rule 6.4.20) <br /> The Colorado Mined Land Reclamation Board("Board")has determined that this foram, if <br /> properly executed, represents an agreement that complies with Construction Materials Rule 6.3.12(n), <br /> Rule 6.4.19(a), and C.R.S. §34-32.5-115(4)(e)and with Hard Rock/Metal Mining Rule 6.3.12(a), Rule <br /> 6.4.20(a), and C.R.S.0 34-3 2-115(4)(d). This form is for the sole purpose of ensuring compliance loth the <br /> Rules and Regulations and shall not make the Board or Division a necessapy park'to anl•private civil <br /> lawsuit to enforce the terms of the agreement or create ani•enforcement obligations in the Board or the <br /> Division. <br /> The foilo-,ling structures are located on or siithin 200 feet of the proposed affected area: <br /> i. Overhead Electric Lines and associated power poles <br /> 2. <br /> 3. <br /> 4. <br /> 5 <br /> (Please list additional structures on a separate page) <br />