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PERM ITTEE/STRUCTU RE 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 San Isabel Electric Association, Inc. own the following structure(s), located <br /> within 200 feet of the permitted mining area: powerlines <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 San Isabel Electric Association, Inc. shall be compensated for any damage from the proposed <br /> mining operation to the above listed structure(s) located within 200 feet of the permitted mining area described in <br /> the MLR 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: 9gaid., �c r!� �r Date: �TH�EEM q.CL <br /> STq ETARYPUQLICENT! <br /> STATE OF Colorado ) MY NOTARY F20QL /C <br /> ss coMMISSlON EXp® 40439 9 <br /> COUNTY OF Pueblo ) / RESN®VFMBER 13 2018 <br /> The foregoing was acknowledged before me this day of ��zi 2017, by <br /> Matthew R. Welte as COO of Summit Brick&Tile CO. <br /> Notary Public: -L� My Commission Expires: x? <br /> NOTARY FOR STRUCTURE OWNER <br /> ACKNOWLEDGED BY: <br /> Structure Owner(s): San Isabel Electric Association, Inc. <br /> Contact name(print): itl( � Title �, Y. .t� 1,))4 Y6 <br /> Signatur — Date; 2 bI <br /> STATE OF ) MI NOOTARY PUBLIC LO <br /> sS STATE F COLORADO <br /> NOTARY D 20174031466 <br /> COUNTY OF ) <br /> f1Ay Commission Expires 07-27-2021 <br /> The foregoing was acknowledged before me this day of 2017, by <br /> 116WIe A 11(�/Af <br /> Notary Public: My Commission Expires: <br /> SENT TO STRUCTURE OWNER VIA CERTIFIED MAIL # 70102780000220634633 <br />