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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 City of Pueblo- Public Works Department own the following structure(s), <br /> located within 200 feet of the permitted mining area: E. 16th St., E. 18th St., North Hudson Ave., North Lacross <br /> Ave., & Ruppel St. <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 City of Pueblo-Public Works Department shall be compensated for any damage from the <br /> proposed mining operation to the above listed structure(s) located within 200 feet of the permitted mining area <br /> described in the MLR Permit for the Native/Pierre Mine. <br /> 140TARY 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: _/� tii!L !� ���� Date: <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 � My Commission Expires: � q �"2 <br /> A CLEMENTI <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY FOR STRUCTURE OWNER NOTARY ID20144043949 <br /> IrMIYCOIMM1SS'O\I.EXPIRES NOVEM©ER 13.2022; <br /> ACKNOWLEDGED BY: ; ' <br /> Structure Owner(s): City of Pueblo- Public Works Department Contact name(print): <br /> Signature: ,-.1 Date: .�" AC? <br /> Title: <br /> STATE OF 10kna G ) <br /> ( )SS <br /> COUNTY OF It J ) <br /> The re oing was lknowleclgecl bqTore met is cZ2 day of tj 20°--; by <br /> Notary Public: My Commission Expires: (O " 23 Ellene Tracey Sample <br /> I NOTARY PUSIX <br /> tI STATE OF COLORADO <br /> 1 NOTARY ID#I=4=10 <br /> i W COMMISSION EXPIRES IOt10/2023 <br /> SENT TO STRUCTURE OWNER. VTA CRR'rTPT.ED MATT, #{ 70181130000165522534 <br />