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L.G. EVER.IST, INC. <br /> RocK Sbuo,9mr F. 1876 9921 E.88n,Aatsaai Svri� 200 <br /> HFwf>F &-,N. Crmmro 80640 <br /> Pmon 303-287-9606 + rAx 303-289-1348 <br /> SANG <br /> PERMITTEE t STRUCTURE OWNER AGREEMENT <br /> By and Between Permittee(LG. Everts#,!no-)and Owners of Structure(s)Listed Below <br /> within 200 feet of proposed sand and gravel mime site <br /> The Colorado Division of Reclamation, Mining and Safety(DRMS), abiding by the Colorado Mined <br /> Land Reclamation (MLR)Law, requires the permit applicantioperator to agree to reimburse the owner <br /> of any permanent man-made structure(s) within 200 feet of the permitted mining area for damage done <br /> to the structure(s) as a result of the permitted operation. <br /> L.G. Everist. Inc. shall be the permittee(applicantloperator) of the following: <br /> Site: West Farm Reservoirs, a proposed sand and gravel mine, which has a reclamation plan of <br /> developed water storage(and is located in parts of Section 14, Township 3 North, Range 67W, <br /> 60 P.M., Town of Platteville, Weld County, Colorado). <br /> Town of Platteville owns the following structure(s)listed below, which are located within 200 feet of the <br /> permitted area: <br /> Structur9e(s): County Road 3Z 5 <br /> The pem-(tee, L.G. Everist, Inc., does hereby certify that the Structure Owner named in this Agreement <br /> shall be compensated for any damage to their Structure(s)named in this Agreement,which islare <br /> located within 200 feet of the permitted area,and damaged as a result of the mining operation to be <br /> known as West Farm Reservoirs. <br /> A notarized signature by a Representative of L.G. Everist, Inc., and a notarized signature by the <br /> Structure Owner(Landowner or Company Representative) in the spaces provided below shall satisfy <br /> the MLR law requirement and certify this agreement. <br /> A copy of the signed notarized agreement shall be kept by L.G. Everist and the Structure Owner. <br /> Signatures on following page <br /> Page 1 of 2 <br /> WF DRMS-ExS-StructureLttter&Agmt-Ptatb WIe-Nov2022 <br />