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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 Housing Authority of Pueblo own the following structure(s), located within 200 <br /> feet of the permitted mining area: House, Fence (1116 Rupple 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 Housing Authority of Pueblo 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: Date: <br /> STATE OF Colorado ) <br /> ) ss <br /> COUNTY OF Pueblo ) <br /> The foregoing was acknowledged before me this_J�day of 2020, by <br /> Matthew R.Welte as CEO of Summit Brick &Tile CO. <br /> Notary Public: /� A�my Commission Expires: <br /> ENTI <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY FOR STRUCTURE OWNE NOTARY ID 20144043949 <br /> MY COMMISSION EXPIRES NOVEMBER 13,2022 <br /> ACKNOWLEDGED BY: �n <br /> Structure Owner(s): Housing tho ityLof Pueblo Contact name (print): <br /> Signature: e: S -1 I <br /> Title: G G <br /> STATE OF <br /> ss <br /> COUNTY OF ) <br /> Th foregoing was acknowledged before me this .` `'/ day of { CC1 20 , by <br /> ,,h�r��-•y / <br /> Notary Public: //�1G--My Commission Expires: E2 }?12t+2 Y <br /> CHERYL L. WILKERSON <br /> NOTARY PLOX <br /> STATE OF COLORADO <br /> NOTARY IDLY 19964w4m <br /> MY COMMISSION EXPIRES 03/08=4 <br /> S17NT TO STRUCTURE: OWNGF. VIA CER'rIPIEU MAIL # 701811.30000165522794 <br />