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PERM ITTEE/STRUCTURE OWNER AGREEMENT <br /> Site: Tract 4 Grading Project <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 permitted area, for damage <br /> done to the structure(s) as a result of the permitted operation. <br /> Janice Evans believes Mountain Mongrels LLC own the following structure(s), located within 200 feet of the <br /> permitted mining area: wire fence (SE corner) <br /> Janice Evans agrees to reimburse you for any damage done to the listed structures as a result of the mining <br /> operation. Your acknowledging signature and a notary seal in the spaces provided below shall satisfy the MLR law <br /> requirement. Janice Evans certifies this agreement as follows: <br /> CERTIFICATION: The Applicant Janice Evans, does hereby certify that Mountain Mongrels LLC shall be <br /> compensated for any damage from the proposed extraction operation to the above listed structure(s)located <br /> within 200 feet of the permitted mining area described in the MLR Permit for the Tract 4 Grading Operation. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEDGED BY: <br /> Permit Applicant: Janice Evans, 33336 FM 1736, Hampstead, TX 77443 <br /> Representative: Janice Evans owner-970-531-7760 <br /> Signatur J Date: '� "� G <br /> STATE OF I C ) <br /> ) ss <br /> COUNTY OF ). ` c ) <br /> The foregoing was acknowledged before me this day of fir ' tr1 , 2020, by <br /> Janice Evans. ---------- <br /> Notary Publics-_ � - My Commission Expires: <br /> NOTARY FOR STRUCTURE OWNER <br /> ACKNOWLEDGED BY: <br /> Structure Owner(s): Mountain Mongrels LLC 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 20_, by <br /> Notary Public: My Commission Expires: <br /> SENT TO STRUCTURE OWNER VIA CERTIFIED MAIL <br />