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PERMITTEEISTRUCTURE 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 Abel and Naomi Sanchez own the following structure(s), located within 200 <br /> feet of the 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 Abel and Naomi Sanchez shall be compensated for any damage from the proposed mining <br /> operation to the above listed structure(s) located within 200 feet of the permitted mining area described in the MLR <br /> Permit for 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:� �/ i , etc' . /G 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 Publi ��..,�my Commission Expires: <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): Abel and Naomi Sanchez <br /> Signature: Date: <br /> Signature: 1 1.0 t, Date:,/{ )'S,0020 <br /> STATE OF(1d xAt 141 C ) <br /> ) SS <br /> COUNTY OF LU10 ) <br /> The foregoin�4 was acknowledged before me this day of I 1 .�,20i�i, by <br /> �Yt_r�rY`P.L <br /> Notary Public: My Commission Expires: P_''I1 i t(1)1_1h Chery k <br /> ( KyQ Notary Public <br /> State of Colorado <br /> Notary 1D#:20004020783 <br /> M Commission Ex ires:08/21/2020 <br /> SENT TO STRUCTURE' ONNER VIA CFRTTFIEU MAIL # 70192970000082391462 <br />