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Varra Companies, Inc. Ma x 1a ° <br /> Office of Special Projects <br /> 8120 Gage Street Frederick Colorado 80516 Telephone(303)666-6657 Fax(303)666-6743 <br /> Statement of Understandin;? <br /> Landowner of Adjacent Structure Statement: Our notarized signature below testifies <br /> we have been proN ided with and opportunity to rex iew: <br /> 1) a Stability Analysis Report pertaining to the proposed Two Rivers Sand Gravel and Reservoir <br /> Project-Regular Impact(112)Permit Application M-2022-013.;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 Two Rivers Sand.Gravel and Reservoir Project- <br /> Regular Impact(112)Permit Application M-2022-013. <br /> Upon review of the available materials reference here or the attending Public Notice; <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 Two Rivers <br /> Sand,Gravel and Reservoir Project-Regular Impact(112)Permit Application M-2022-013., <br /> Further, by our signatures, as notarized below, we concur that planned activities detailed in the <br /> application for permit M-2022-013.; 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 such <br /> structures as a direct result of authorized active operations,those damages will be compensated for by <br /> the Operato consistent th established law. <br /> 2022 <br /> Signature of A jacent Landowner Date - <br /> As,/is � �Iio9 ems�ir� <br /> Print Name <br /> State of <br /> !!. � )ss. <br /> County of <br /> J , <br /> The foregoing instrument was acknowledged befo me this day of y�� ')02', <br /> by �.-�W t a_, I cs L V t h �a for <br /> ). Title <br /> Company or Corporation - ) <br /> Notary Public <br /> LORRI ANN CARLSON <br /> NOTARY PUBLIC My Commission expires: <br /> STATE OF COLORADO <br /> NOTARY ID <br /> M 2 <br /> Y COMMISSION EXPIRES MARCH 02,2025 <br />