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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 Daniel & Donna Hahn own the following structure(s), located within 200 feet of the <br /> permitted mining area: power pole and line (SE corner) 2- Wire fences <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 Daniel & Donna Hahn 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): Daniel & Donna Hahn <br /> Signature) ,_ o t . � Date: "l5 — ,1a <br /> Signature: t v`�- _ Date: (vim^ <br /> STATE OF 006VO-Ck) ) U <br /> ss <br /> COUNTY OF G?Yo,11C ) <br /> The foregoing was acknowledged before me this I S tit day of JU nC 205C, by <br /> O&R I r'1 L f Gt h it 0 ri QOK Ka Ffrz h n ��.�. K e,/ L /4t ILA Q S <br /> 0.dc)VItt'(-', to ac` <br /> Notary Public) My Commission Expires: <br /> 0,e0v ICH Q t 1,45"�•rr 1t 1 LD <br /> CAN^D{IICy�E/SpIIEpF�KyEN <br /> $ 'NT TO ST'.(JNYKI/�i'T� rPUB .IC',;TT FTFD MA. , <br /> STATE OF COLORADO <br /> NOTARY ID 2007403&W7 <br /> MY COMMISSION EXPIRES SEPTEWER 26,2023 <br />