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L.G. EVERIS T', INC. <br /> rm .20fl7321 E. e <br /> ti E x::x&w-ji)Sav, 1876 <br /> H rrx>e.zaSO N, CouruArxx 80640 <br /> NONF 303—287-96 • f'AX 03-289, -1 348 <br /> ?txx b. .,:. _._. .......... ........... _......... .......... ..........................—_._......_.._._ .. ._.. <br /> PERMITTEE / STRUCTURE OWNER AGREEMENT <br /> The Colorado Division of Reclamation, Mining and Safety(DRMS), abiding by the State of Colorado, Mined Land <br /> Reclamation (MLR) Law, requires the permit applicant/operator to agree to reimburse the owner of any permanent <br /> man-made structure(s)within 200 feet of the permitted mining area for damage done to the structure(s) as a result <br /> of the permitted operation. <br /> L.G. Everist, Inc. operates the Firestone Gravel Resource, DRMS Permit M- -052, a sand and gravel mine. <br /> Town of Firestone owns the following structure(s), which are located withi 0 f f the permitted area: <br /> - Fences, Zinnia and Holiday Streets <br /> L.G. Everist, Inc. agrees to, and certifies this agreement as follo <br /> The permittee, L.G. Everist, Inc., does hereby certify that the a -named w er shall be compensated for <br /> any damage to the above-listed Structure(s), which is t it 00 f f the permitted area, as a result <br /> of the mining operation known as Firestone Gravel ource `x R it M-1996-052. <br /> A signature by a representative of the Town of Fire ne tary seal in the spaces provided below shall <br /> satisfy the MLR law requirement. A copy of the si of d agreement shall be kept by L.G. Everist and the <br /> Structure Owner. <br /> NOTARY FOR PERMIT APPLICANT NOTARY FOR STRUCTURE OWNER <br /> ACKNOWLEDGED BY: ACKNOWLEDGED BY: <br /> Permittee: L.G. Everist Inc. Owner(s): <br /> Mail Address: 7321 E 88t ve. S 0 Mail Address: <br /> Hender 806 <br /> Contact: L nn , hults—Reaularory Mgr. Contact (if different than owner): <br /> 303-2. - Z. J'E,u M V <br /> Signature: Signature: <br /> Date: Date: <br /> STATE OF Colorado ) STATE OF Colorado ) <br /> ) ss ) ss <br /> COUNTY OF Adams ) COUNTY OF ) <br /> The foregoing was acknowledged before me this The foregoing was acknowledged before me this <br /> day of 2019, day of 20 <br /> by Lynn M. Shults as Regulatory Manager of L.G. by of <br /> Everist, Inc. <br /> Notary Public: Notary Public: <br /> My Commission Expires: My Commission Expires: <br /> 7,• Fnvirnnmenf Inc -Structure letters wnrl <br />