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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 ralmburae the owner of any pormanont man-modo ctrueturo(c)within 200 foot 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 Bonnie Jo Soltman French own the following structure(s), located within 200 <br /> feet of the permitted mining area: 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 Bonnie Jo Soltman French 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: ��1�.�/ Date: Z7NOTARY <br /> LEEN A.CLEMENTI <br /> STATE OF Colorado OTARY PUBLIC <br /> TE OF COLORADO <br /> )sS ID 20144043949 <br /> COUNTY OF Pueblo ) N EXPIRES NOVEMBER 13,2018 <br /> The foregoing was acknowledged before me this e/.- day of J-ta Zi , 2017, by <br /> Matthew R. Welte as COO of Summit Brick&Tile CO. <br /> ��Notary Public: z4l " � My Commission Expires: <br /> NOTARY FOR STRUCTURE OWNER <br /> ACKNOWLEDGED BY: <br /> Structure Owner(s): Bonnie Jo Soltman French <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 # 7 0102 78 000022 063 02 97 <br />