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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 Holly Y Barto own the following structure(s), located within 200 feet of the <br /> permitted mining area: House, Fence <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 Holly Y Barto 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: ti,lci,t���c���C'r � Date: <br /> STATE OF Colorado ) <br /> ) ss <br /> COUNTY OF Pueblo ) , /J <br /> The foregoing was acknowledged before me this 21 S day of 2020, by <br /> Matthew R. Welte as CEO of Summit Brick & Tile CO. <br /> Notary Public: �tii•G My Commission Expires: -���—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): Holly Y Barto <br /> Signature: Date: <br /> f" - <br /> STATE OF�drQ)O ) <br /> , ��/ <br /> COUNTY OF 4WJ )ss <br /> The for gong s cknowledged before me this day of < 20 by <br /> r� <br /> Notary Public: y Commission Expires: <br /> ZACHARY K I YARTiN <br /> NOTARY PUEc.IC <br /> STATE OF COLORADO <br /> NOTARY iD 201 74040568 <br /> MY COMMISSION EXPIRES SEPTEMBER 28,2021 <br /> SENT TO STRUCTURE OWNER VIA CERTIFIED MAIL fl 7019297000004461.7241 <br />