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PERM ITTEE/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 Ricky R& Bessie E Langdon own the following structure(s), located within 200 <br /> feet of the permitted mining area: House, fence, out building, 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 Ricky R& Bessie E Langdon 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 /> / <br /> Y l /� F �.L Date: � bL2�oi <br /> Signature: . 04 �k`1 � <br /> STATE OF Colorado <br /> )SS <br /> COUNTY OF Pueblo ) �� <br /> The foregoing was acknowledged before me this e�day of _ 2017, by s <br /> Matthew R. Welte as COO of Summit Brick&Tile CO. <br /> �� '�/�M p <br /> Notary Public:, y Commission Expires: <br /> NOTARY FOR STRUCTURE OWNER <br /> ACKNOWLEDGED BY: <br /> Structure Owner(s): Ricky R Langdon & Bessie E Langdon <br /> Signature: Date: <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 # 70102780000220634459 <br />