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L.G. EVEMST, INC. <br /> 7321 E. 88'rta AVENUE.Suns 200 <br /> Rocx SouD SwcE 1876 <br /> HFrrDr•.RsoM, COI.ORADO 80640 <br /> PHONE 303-287-9606 • FAx 303-289-1348 <br /> LAND <br /> PERMITTEE /STRUCTURE OWNER AGREEMENT <br /> By and Between Permittee(L.G. Everist, Inc.)and Owners of Structure(s)Listed Below <br /> within 200 feet of proposed sand and gravel mine site <br /> The Colorado Division of Reclamation, Mining and Safety(DRMS), abiding by the Colorado Mined <br /> Land Reclamation (MLR) Law, requires the permit applicant/operator 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 (applicant/operator) 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 /> 61h P.M., Town of Platteville, Weld County, Colorado). <br /> Central Weld County Water District owns the following structure(s) listed below, which are located <br /> within 200 feet of the permitted area: <br /> Structure(s): 2-water lines <br /> The permittee, 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 is/are <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-StructureLetter&Agmt-CWCWD-Nov2022 <br />