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PERMITTEE/STRUCTURE OWNER AGREEMENT <br /> Mine: Native/Pierre Mine -M-1977-321 <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 mining area, for <br /> damage done to the structure(s) as a result of the permitted operation. <br /> Summit Brick and Tile Co. believes Lynette K Lievers own the following structure(s), located within 200 feet of the <br /> permitted mining area: House <br /> Summit Brick and Tile Co. 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 /> MLR law requirement. Summit Brick and Tile Company certifies this agreement as follows: <br /> CERTIFICATION: The Applicant Summit Brick and Tile Co. represented by Matthew R. Welte as CEO, does <br /> hereby certify that Lynette K Lievers shall be compensated for any damage from the proposed mining operation to <br /> the above listed structure(s) located within 200 feet of the permitted mining area described in the MLR Permit for <br /> the Native/Pierre Mine. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEDGED BY: <br /> Permit Applicant: Summit Brick and Tile Co. P.O. Box 533 Pueblo 81002 <br /> Representative. Matthew R.Welte CEO-719-542-8278 <br /> Signature: A''1 U&'a_, �7 � Date: "sL/ -27-d <br /> STATE OF Colorado ) <br /> ) SS <br /> COUNTY OF Pueblo ) <br /> The foregoing was acknowledged before me this day of 2020, by <br /> Matthew R.Welte as CEO of Summit Brick &Tile CO. <br /> Notary Publi My Commission Expiretj5n <br /> NTI <br /> PUBLIC <br /> NOTARY FOR STRUCTURE OWOLORADO <br /> 0144043949ACKNOWLEDGED BY: S NOVEM13ER 13.2022 <br /> Structure Owner(s): Lynette K Lievers <br /> Signature; L,� Date:�o Z/ZDZ� <br /> STATE OF I016PWi& ) <br /> ) ss <br /> COUNTY OF ) <br /> Tr fo oin as ackn wledged befor me thidnzday of ,2OX,by <br /> V <br /> Notary Publi Commission Expires: <br /> RENA J GONZALES <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 201240 7 8173 <br /> MY COMMISS!ON EXPIRES DECEMBER 5,2020 <br /> SENT 'ro STRucruRE OWNER VTA CERTIFIED MAIL ff 70181130000165522749 <br />