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PERMITTEE/STRUCTURE OWNER AGREEMENT <br /> Mine: Fox No 1 Clay Pit-M-1977-219 <br /> State of Colorado, Mined Land Reclamation (MLR) law requires the permit applicant(operator/permittee)to agree <br /> to reimburse the owner of any permanent man-made structure(s)within 200 feet of the permitted mining area, for <br /> damage done to the structure(s) as a result of the permitted operation. <br /> Summit Brick and Tile Co. believes Dennis Allee, Deana Kasel, & Donna Levare& Deana Kasel, Donna Levar& <br /> Dennis Allee, Revocable Trust own the following structure(s), located within 200 feet of the permitted mining area: <br /> fences <br /> Summit Brick and Tile Co. agrees to reimburse you for any damage done to the listed structures as a result of the <br /> mining operation. Your acknowledging signature and a notary seal in the spaces provided below shall satisfy the <br /> MLR law requirement Summit Brick and Tile Company certifies this agreement as follows: <br /> CERTIFICATION: The Applicant Summit Brick and Tile Co. represented by Matthew R. Welte as COO, does <br /> hereby certify that Dennis Allee, Deana Kasel, & Donna Levare& Deana Kasel, Donna Levar& Dennis Allee, <br /> Revocable Trust shall be compensated for any damage from the proposed mining operation to the above listed <br /> structure(s) located within 200 feet of the permitted mining area described in the MLR Permit for the Fox No. 1 <br /> Clay Pit. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEDGED BY: <br /> Permit Applicant: Summit Brick and Tile Co., P.O. Box 533, Pueblo 81003 <br /> Representative: Matthew R. Welte, COO-719-542-8278_ <br /> &L�&60& <br /> CMY <br /> EEN A.CLEMENTI <br /> Signature: f 66zV'?- Date: C� ��'� STATEARYPUBLIC <br /> LORADO <br /> NOTARY ID 20';44043949 <br /> STATE OF Colorado ) MISSION EXPIRES NrivEMBER 13,20+b <br /> ) ss <br /> COUNTY OF Pueblo ) <br /> The foregoing was acknowledged before me this��y of 2017, by <br /> Matthew R. Welte as COO of Summit Brick&Tile CO. <br /> Notary Public:� lG�y Commission Expires: <br /> NOTARY FOR STRUCTURE OWNERS <br /> ACKNOWLEDGED BY: <br /> Structure Owner(s): Dennis Allee Donna Levare& Deana Kasel Donna Levar& Dennis Allee, Revocable Trust <br /> Contact name (print): s' Title <br /> Signature: <br /> � Date: <br /> STATE OF ZlorCr� ) <br /> ss <br /> COUNTY OF &e_hl ) <br /> The foregoing was acknowledged before me this day off , 2017, by <br /> bwA�a offAL <br /> Notary Public: My Commission Expires: <br /> SENT TO STRUCTURE OWNER VIA CERTIFIED MAIL # 70102780000220634541 <br /> THERESA MAURELLO <br /> i NOTARY PUBLIC <br /> STATE CIS= COLORADO i <br /> i NOTAR f ID 19924014366 <br />