Laserfiche WebLink
PERMITTEE/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 /> Signature: Date: <br /> STATE OF ) <br /> ) ss <br /> COUNTY OF ) <br /> The foregoing was acknowledged before me this day of 2020, by <br /> Janice Evans. <br /> Notary Public: My Commission Expires: <br /> NOTARY FOR STRUCTURE OWNER <br /> ACKNOWLEDGED BY: <br /> Structure Owner(s): Mountain ongrels LLC Contact name (print): �/ `t C"2!- s"_ "-/c <br /> Signature: '� Date: <br /> Title: ✓n6—,zP 2e <br /> STATE OF C 0lur6(C4D ) <br /> COUNTY OF 61rap'C4 ss <br /> ) <br /> The foregoing was acknowledged before me this it`=a day of J 01 20_2g by <br /> Notary Public: My Commission Expires: `a' 5 (- �3 <br /> CM4=E S*FKEN <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> s wr ro SWTARRY l��Qd�>� ��r•5�, <br /> myCOiA m"Inu <br />