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PERM ITTEE/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 Linda D Serviss own the following structure(s), located within 200 feet of the <br /> permitted mining area: House, Fence, Shed <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 Linda D Serviss 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: ' t�/���.lC Date: f� U <br /> STATE OF Colorado ) <br /> ) Ss <br /> COUNTY OF Pueblo ) ('�_ / <br /> The foregoing was acknowledged before me this �J �d"ay of 2020, by <br /> Matthew R.Welte as CEO of Summit Brick&Tile CO. <br /> Notary Publi4, e24.- /// ,/i '_X_"y Commission Expires: /��» ✓/ �!/�•• —2 <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): Linda D Serviss f <br /> Signature: r&M d4, A • c7 PWt&2- Date: '5-.2.;'— o <br /> STATE OF 0 C_j 'C' ) <br /> 1 SS <br /> COUNTY OF "� <br /> T e�foregoing was acknowledged before me this iT day of �� x�i� 20�Z=, by <br /> t L d orti= L (__--r C i c <br /> otaVublic: Mv Commission Expires: <br /> t / NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20104M727 <br /> MY COMMISSION EXPIRES 3/1/202Z <br /> SEW 'ro STRUCTURF OWNER VIA CERTIFIED MAIL, 4 70192970000082391486 <br />