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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 Theresa&Thomas Goodrich own the following structure(s), located within 200 <br /> feet of the permitted mining area: fence <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 Theresa &Thomas Goodrich 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 /> KA, III A.CLENIENTI <br /> Signature: // ,�t" l�L�:� Date: �G/ NOTARYPBBLIC <br /> STATE O-COLORADO <br /> STATE OF Colorado ) NOTARY iD '0144043949 <br /> ) ss MY CQ--- M--INN EXPIRES NOVEMBER 1312018 <br /> COUNTY OF Pueblo <br /> The foregoing was acknowledged before me this day of� ���'' � 2017, by <br /> Matthew R. Welte as COO of Summit Brick&Tile CO. <br /> ��� G i p <br /> Notary Public:� y Commission Ex Tres:_ <br /> NOTARY FOR STRUCTURE OWNERS <br /> ACKNOWLEDGED BY: <br /> Structure Owner(s): Theresa Goodrich &Thomas Goodrich <br /> Signature: -- r ,.. Date' <br /> Signature: Date: ; C <br /> STATE OF <br /> ) ss <br /> COUNTY OF ( � I ) <br /> The foregoing was acknowledged before me this -! day of wi k' ,� =.� 2017, by <br /> PEREZNOTARY PUBLIC <br /> ' 33807 <br /> A OLORADO33807 <br /> Notary Publici .E ` l. T4l zMy Commission Expires: J;ANJEANETTE <br /> oMMisSioN EXPIRES 09 0212020 <br /> SENT TO STRUCTURE OWNER VIA CERTIFIED MAIL # 70102780000220634589 <br />