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Structure and Land Damage Claim Form

Please complete and submit this form to report structure and/or land damages caused by active underground mining to the California District Office.  To report all other damages (e.g. water loss) caused by active underground mining contact our mine subsidence hotline at (800) 922-1678.

We will process your request as soon as possible, however this may take up to two weeks depending on our workload.

Please do not use this form unless the following apply to you:

  • You have structure and/or land damage that you believe to be caused by active mining and,

  • It has been six months since you initially contacted the Mine Operator regarding the damage and/or,

  • Negotiations between you and the Mine Operator have ceased unsuccessfully.

To receive a paper copy of this form or to ask a question regarding this form contact our mine subsidence hotline at (800) 922-1678.

You will receive an e-mail acknowledgment that your complaint has been received and referred for action.

DEP staff will provide you with information on the status of our investigation by telephone or in writing.

* All Fields in This Form are Required

Silver Bar

Use the TAB key to move through the fields and then click on the SUBMIT button to send the form. Pressing the ENTER key will send an incomplete form which will delay processing.

Your Name:
Email Address:
Street Address:
City:
Zip Code:
Daytime Phone:
Township:
County:
Description of Problem:
(Please describe your problem in detail)
When was the problem first discovered?:
Are you aware of any adjacent property owners experiencing similar problems?: Yes     No
Do you have a current Mine Subsidence Insurance Policy on this structure?: Yes      No
Have you ever had a Mine Subsidence Insurance Policy on this structure?: Yes      No
When was this structure built?:
How long have you occupied this structure?:
Who do you think is responsible for the problem?
Operator Name:
Mine Name:
Please provide a detailed description of the location of your property so that we can research the surface and underground conditions at your site:

Bureau of Mining Programs District Mining Operations Bureau of Mine Safety Bureau of Abandoned Mine Reclamation