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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 Bernard &Jacqulin Elliott own the following structure(s), located within 200 <br /> feet of the permitted mining area: House, out buildings, Fences,water well <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 Bernard &Jacqulin Elliott shall be compensated for any damage from the proposed mining <br /> operation to the above listed structure(s) located within 200 feet of the permitted mining area described in the MLR <br /> Permit for the Fox No. 1 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 /> Signature: ///l.f�U& �LCG Date: t �� STgN®gtNyA•C4 <br /> �t4fN/S074,y 7-e .U, CT/ <br /> STATE OF Colorado j ssMY '=? v4�/ DO <br /> l <br /> COUNTY OF Pueblo ) ^:r"jl �39q <br /> 9 <br /> HOER <br /> The foregoing was acknowledged before me this�day of T�� "z- 2017, by z0 p <br /> Matthew R. Welte as COO of Summit Brick&Tile CO. <br /> Notary Public: /2i A��My Commission Expires ��C� <br /> NOTARY FOR STRUCTURE OWNERS <br /> ACKNOWLEDGED BY: <br /> Structure Owner(s): Bernard Elliot&Jacqulin Elliott <br /> Signature: ta:.: N'` ``"".' Date: <br /> Signature: , Date: a 2,li <br /> — ERRIN 130PdCORE <br /> STATE OF Oct ' ':.0 ) i N<,tary Public <br /> ) ss State of Colorado <br /> COUNTY OF ��s.�Wly ) Notary lD#201 44017820 <br /> My Ccrnmis�i ,i -xpires 04-25-20 <br /> The foregoing was acknowledged before me this day of 2017, by <br /> Notary Public: My Commission Expires: �a sla j <br /> SENT TO STRUCTURE OWNER VIA CERTIFIED MAIL # 70102780000220634572 <br />