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PERM ITTEE/STRUCTURE OWNER AGREEMENT <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 structure(s)within 200 feet of the Becker Pit (M-2020-022) <br /> permitted mining area, for damage done to the structure(s) as a result of the permitted operation. <br /> Austin & Betsy Clennin believes the Colorado State Land Board owns the following structure(s), located within 200 <br /> feet of the permitted mining area: dirt road <br /> Austin & Betsy Clennin, 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 /> MINED LAND RECLAMATION BOARD law requirement. Austin & Betsy Clennin certifies this agreement as <br /> follows: <br /> CERTIFICATION: The applicant Austin & Betsy Clennin represented by Austin Clennin, as an owner, does hereby <br /> certify that the Colorado Land Board shall be compensated for any damage from the proposed mining operation to <br /> the above listed structure located within 200 feet of the permitted mining area described in the MINED LAND <br /> RECLAMATION BOARD Permit for the Becker Pit. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEDGED BY: <br /> Permit Applicant: Austin & Betsy Clennin, 10826 Clennin Road, Rye, CO 81069 <br /> Representative: Austin Clennin, owner phone 719 -251-2996 <br /> Signature: Date: <br /> STATE OF Colorado ) <br /> ) ss <br /> COUNTY OF Huerfano ) <br /> The foregoing was acknowledged before me this day of by <br /> Austin Clennin as the owner of the Becker Pit. <br /> Notary Public: My Commission Expires: <br /> NOTARY FOR STRUCTURE OWNER(s) <br /> ACKNOWLEDGED BY: <br /> Structure Owner(s): Colorado State Land Board Contact name (print): <br /> Signature: Date: <br /> Title: <br /> STATE OF ) <br /> ) ss <br /> COUNTY OF ) <br /> The foregoing was acknowledged before me this day of by <br /> Notary Public: My Commission Expires: <br />