20230801_Easement

NORTH CAROLINA MINING State of North Carolina 1612 Mail Service Center
PERMIT APPLICATION Department of Environmental Quality Raleigh, NC 27699-1612
Division of Energy, Mineral, and Land Resources [phone]
G.LAND ENTRY AGREEMENT
We hereby grant to the Department or its appointed representatives the right of entry and travel upon our lands or operation
during regular business hours for the purpose of making necessary field inspections or investigations as may be reasonably
required in the administration of the Mining Act of 1971 pursuant to G.S.74-56.
We further grant to the Department or its appointed representatives the right to make whatever entries on the land as may be
reasonably necessary and to take whatever actions as may be reasonably necessary in order to carry out reclamation which the
operator has failed to complete in the event a bond forfeiture is ordered pursuant to G.S.74-59.
LANDOWNER: APPLICANT:
Signature Signature*
Print Name Melton Valentine III Print Name Melton Valentine III
Title(if applicable) President Title Owner
Company(if applicable) Havelock Drugstore,LLC. Company Havelock Drugstore, LLC.
Address 414 N.Main Street,Tarboro Mine Name Havelock Drugstore Mine
NC,27886 Telephone [phone]
Telephone [phone] Date Signed
Date Signed
**This form is dedicated for land entry for the deeded access easement as recorded in the Martin County
register of deeds DB.0-28 PG.766 and Map Book 7 page 5.**
*Signature must be the same as the individual who signed Page 1 of this application.
One original and five(5)copies of the completed application,six(6)copies of all location maps,mine maps and
reclamation maps,and the appropriate processing fee in the form a check or money order payable to the North Carolina
Department of Environmental Quality must be sent to the Raleigh Central Office at the address listed on the front cover
of this application form.
Inquiries regarding the status of the review of this application should be directed to the Mining Program staff at(919)707-9220.
Revised September 21, 2021 Page 119