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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 Sara Herrera 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 Sara Herrera shall be compensated for any damage from the proposed mining operation to the <br /> above listed structure(s) located within 200 feet of the permitted mining area described in the MLR Permit for the <br /> 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: �i�`G(f�,°t.t.GCGt Date: �5 <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 Public;/,4�-) 4%� Nly Commission Expires: �-�i A1717.Z <br /> KATHLEEN A CLEMENTI <br /> NOTARY PUBLIC <br /> NOTARY FOR STRUCTURE OWNER STATE OF COLORADO <br /> NOTARY ID 20144043949 <br /> ACKNOWLEDGED BY: MY COMMISSION EXPIRES NOVEMBER 13,2022 <br /> Structure Owner(s): Sara Herrera <br /> " e <br /> Signature: 1 Q ial _ ate: _ <br /> STATE OF ONO((,t } <br /> COUNTY OF �� _ ss <br /> Tf e foregoing Was acknowledged before me this day of ,201?by <br /> 1- C-: <br /> Notary Public: My Commission Expires: <br /> WENDY SUE HARRISON <br /> V NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20094010957 <br /> MY COMMISSION EXPIRES APRIL 01,2021 <br /> SENT TO STRUCTURE OWNER VIA CERTIFIED MA11. # '70181130000165522596 <br />