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PERMITTEE/STRUCTURE OWNER AGREEMENT <br /> M&G Pit Permit#M-1985-079 <br /> State of Colorado,Mined Land Reclamation(MLR)law requires the permit applicant(operator/permittee)to agree to <br /> reimburse the owner of any permanent man-made structure(s)within 200 feet of the permitted mining area for damage done <br /> to the structure(s)as a result of the permitted operation. <br /> Mann Lake Holdings LLC.believes South Adams County Water& Sanitation District shall own the following <br /> structure(s),located within 200 feet of the permitted mining area Fence,Waterline and Appurtenances. <br /> Mann Lake Holdings agrees to reimburse you for any damage done to the listed structures as a result of the mining operation. <br /> Your acknowledging signature and a notary seal in the spaces provided below shall satisfy the MLR law requirement. Mann <br /> Lake Holdings certifies this agreement as follows: <br /> CERTIFICATION: The Applicant Mann Lake Holdings LLC represented by Joseph M. O'Dea ,as the Manager <br /> does hereby certify that South Adams County Water&Sanitation District shall be compensated for any damage from <br /> the proposed mining operation to the above listed structure(s)located within 200 feet of the permitted mining area <br /> described in the MLR Permit for the M&G Pit. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEDGED BY: <br /> Permit Applicant:Mann Lake Holdings LLC,2027 W.Colfax Avenue,Denver CO 80204 <br /> Representative: Joseph M.O'Dea,Manager,303.562.2000 <br /> JESSICA <br /> NORY PUBLIC <br /> Signature: Date: (01 lQ .O 1.1 STATE TA <br /> COLORADO <br /> NOTARY ID 20084035981 <br /> STATE 0 Colorado ) COKTISSION 2020 <br /> S OCTOBER 15, <br /> ss <br /> COUNTY OF Denver ) <br /> The foregoing was acknowledged before me this lllth day of UC7r',br.( ,2017,by Joseph M. <br /> O'Dea as the Manager of Mann Lake Holdings,LLC. <br /> ` ��� / ,9 <br /> 06 •0 <br /> Notary Publ'�_ `A � . My Commission Expires: CTI <br /> J <br /> NOTARY FOR STRUCTURE OWNER <br /> ACKNOWLEDGED BY: <br /> Structure Owner(s): Contact name(print): <br /> Signature: Date: <br /> STATE OF ) <br /> )ss <br /> COUNTY OF ) <br /> The foregoing was acknowledged before me this day of ,2017,by <br /> • <br /> Notary Public: My Commission Expires: <br /> SENT TO STRUCTURE OWNER VIA CERTIFIED MAIL # <br />