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Fk . <br /> +niwnr°` <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-1996-052, a sand and gravel mine. <br /> Terrence S & Lisa M Haley owns the following structure(s), which are located within 200 feet of the permitted <br /> area: <br /> House, garage, barn, 3-sheds,wire fences,2 silos <br /> L.G. Everist, Inc. agrees to, and certifies this agreement as follows: <br /> The permittee, L.G. Everist, Inc., does hereby certify that the above-named Owner shall be compensated for <br /> any damage to the above-listed Structure(s), which is located within 200 feet of the permitted area, as a result <br /> of the mining operation known as Firestone Gravel Resource, DRMS Permit M-1996-052. <br /> A signature by Terrence S & Lisa M Haley and a notary seal in the spaces provided below shall satisfy the MLR <br /> law requirement. A copy of the signed notarized agreement shall be kept by L.G. Everist and the 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 88th Ave. Suite 200 Mail Address: <br /> Henderson, CO 80640 <br /> Contact; Lynn M. Shults, Regulatory Mqr. Contact(if different than owner): N3 t P•. <br /> 303-286-2247 <br /> Signature: Signature: <br /> Date: r/J '' � Signature: <br /> V' <br /> Date: <br /> STATE OF Colorado ) <br /> ) ss <br /> COUNTY OF Adams ) STATE OF Colorado ) <br /> ss <br /> The foregoing was acknowledged before me this COUNTY OF �L: '.t- ,.0 <br /> 2-1 day of I ow 2019, <br /> by Lynn M. Shults as Regulato Manager of L.G. The foregoing was acknowledged before me tW <br /> Everist, Inc. ��fL%day of 20Z, <br /> `t by °:z,emu C { r c-1 of I-)"k(G e t 17 41tZ4It GG, <br /> Notary Public:4 C <br /> My Commission Expires:C,-�f O7 Notary Public: <br /> My Commission Ex it <br /> OEMA AM THOMPSON <br /> NOTARY PUBLIC r�, P a b)i s <br /> STATE OFCOLORADO of Colorado <br /> NOTARY 0=10403Q7 f[J 0 2 00440064 s S <br /> IAYOOIIOI1118"9VOMiOCTOM07.7000 , cit EUt[•SC�7 u i <br /> 7• Fnvi?-nnmvn1 /nr -.Cirurfura ivlforc wnd Y �. <br />