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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 <br /> significant, valuable and permanent man-made structure located within two hundred (200) feet of <br /> the affected land, the Applicant shall either: <br /> a) Provide a notarized agreement between the Applicant and the Person(s) having an <br /> interest in the structure, that the Applicant is to provide compensation for any damage <br /> to the structure; or <br /> b) Where such an agreement cannot be reached, the Applicant shall provide an <br /> appropriate engineering evaluation that demonstrates that such structure shall not be <br /> damaged by activities occurring at the mining operation; or <br /> c) Where such structure is a utility, the Applicant may supply a notarized letter, on <br /> utility letterhead, from the owner(s) of the utility that the mining and reclamation <br /> activities, as proposed, will have"no negative effect" on their utility. ( Construction <br /> Materials Rule 6.3.12 and Rule 6.4.19 &Hard Rock/Metal Mining Rule 6.3.12 and <br /> Rule 6.4.20) <br /> The Colorado Mined Land Reclamation Board("Board") has determined that this form, <br /> ifproperly executed, represents an agreement that complies with Construction Materials Rule <br /> 6.3.12(a), Rule 6.4.19(a), and C.R.S. §34-32.5-115(4)(e) and with Hard Rock/Metal Mining <br /> Rule 6.3.12(a), Rule 6.4.20(a), and C.R.S. §34-32-115(4)(d). This form is for the sole purpose of <br /> ensuring compliance with the Rules and Regulations and shall not make the Board or Division a <br /> necessary party to any private civil lawsuit to enforce the terms of the agreement or create any <br /> enforcement obligations in the Board or the Division. <br /> The following structures are located on or within 200 feet of the proposed affected area: <br /> 1. Jay Ducray - Leach field/septic, Residence, Water Tap, and New Dwelling <br /> 2. Postal Service"" <br /> 3. CERTIFIED o RECEIPT <br /> 4. ru Domestic <br /> 5. M7ees <br /> (Please list <br /> �" t:-,: USE <br /> u1 ,y .iCIA., c1r, <br /> f71 (check box,add tee ao ) <br /> ❑Return Receipt(hard <br /> copy) $ <br /> r-1 ❑Return Receipt(electronic) $ Post d2 <br /> 1—_3 ❑Certified Mail Restricted Delivery $ !! I CJ H gg1� <br /> C3 ❑Adult Signature Required $ — V <br /> ❑Adult Signature Restricted Delivery$ Q� <br /> m $ rj7g/�il19 <br /> � Total Postage and Foes -c <br /> r� $ <br /> Cc Sent To <br /> r=1 --------- <br /> E3Street a- Apt.No.,or P ----- --------------------•------------------------ <br /> r` --. tJ / -- ---------------------- <br /> Ct to ZIP+ ® -"' '--- <br /> Jzr /mac <br /> t <br />