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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 ctructure(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 Dennis Allee, Deana Kasel, &Donna Levare & Deana Kasel, Donna Levar& <br /> Dennis Allee, Revocable Trust own the following structure(s), located within 200 feet of the permitted mining area: <br /> 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 Dennis Allee, Deana Kasel, &Donna Levare& Deana Kasel, Donna Levar& Dennis Allee, <br /> Revocable Trust shall be compensated for any damage from the proposed mining operation to the above listed <br /> structure(s) located within 200 feet of the permitted mining area described in the MLR Permit for the Fox No. 1 <br /> 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 /> &t�� r �- t!�ir Date: �p KATHLEEN A.CLEMENTI <br /> Signature: NOTARY PUBLIC <br /> STATE OF COLORADO <br /> STATE OF Colorado ) NOTARY ID 20144043949 <br /> )SS MY COMMISSION EXPIRES NOVEMBER 13,2018 <br /> COUNTY OF Pueblo ) / <br /> The foregoing was acknowledged before me this day of��e�dt��•-��'�J , 2017, by <br /> Matthew R. Welte as COO of Summit Brick&Tile CO. <br /> Notary Public:,,C My Commission Expires: <br /> NOTARY FOR STRUCTURE OWNERS <br /> ACKNOWLEDGED BY: <br /> Structure Owner(s): Dennis Allee, Donna Levare& Deana Kasel, Donna Levar& Dennis Allee. Revocable Trust <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 k 70102780000220634541 <br />