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PERMITTEE/STRUCTURE OWNER AGREEMENT <br /> Mine: Fox No 1 Clay Pit-M4977-219 <br /> State of Colorado, Mined Land Reclamation (MLR)law requires the permit applicant(operator/permittee)to agree <br /> to reimbureo tho ewnor of any pormanont man-madQ structures)within 700 fe.P.t Of the penitted minim area.for <br /> damage done to the structure(s)as a result of the permitted operation. <br /> Summit Brick and Tile Co. believes J A T Investments LLC own the following structure(s), located within 200 feet <br /> of the permitted mining area: house,water well &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 Summit Pressed Brick& Tile CO. <br /> &J A T Investments LLC shall be compensated for any damage from the proposed mining operation to the above <br /> listed structure(s) located within 200 feet of the permitted mining area described in the MLR Permit for the Fox No. <br /> 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 /> KATHLEEN A.CLEIENTI <br /> Signature: Date: VZO1 TMY <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 21N440439N <br /> STATE OF Colorado ) MmN EXPIRES NOVEIMBt 17,2018 <br /> )ss <br /> COUNTY OF Pueblo ) / <br /> The foregoing was acknowledged before me this day of `ZG2 ze'-'/y , 2017, by <br /> Matthew R.Welte as COO of Summit Brick&Tile CO. <br /> Notary Public: �� �i! L�ii.."y Commission Expires: tom/ <br /> NOTARY FOR STRUCTURE OWNER <br /> ACKNOWLEDGED BY: <br /> Structure Owner(s): J A T Investments LLC <br /> Contact name(print): Title <br /> Signature: Date: <br /> STATE OF ) <br /> )ss <br /> COUNTY OF ) <br /> The foregoing was acknowledged before me this day of , 2017, by <br /> Notary Public: My Commission Expires: <br /> SENT TO STRUCTURE OWNER VIA CERTIFIED MAIL # HAND DELIVERED <br />