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<br />LAND SURVEY MONUMENT <br /> <br />Depa.rlfMnt 01 Rs~ AgmcWS <br />Bov.-rd 01 Rsgistr4tWn. lor ProlssriIYMJ ~srs cmd ProIS$S'l.onal Lam,d. S'UlMJS'/JO'fS <br />f 560 BrocdwGy. S'lAte 1370. Dmwr. CO 80202 <br />Phona (803) 894-7788 · F= (808) 894-7790 · TDD (803) 894-2900X888 <br /> <br />RECORD <br /> <br />.J <br />COLORADO <br /> <br />I <br /> <br />REPORT ONE MONUMENT ONLY ON THIS FORM - REPRODUCTION OF THIS FORM IS AUTHORIZED <br />tems to be filled in by the Lond Surv~yor using PERNANENT BLACK LETTER/NG and lines which con be reproduced <br /> <br />I <br /> <br />All <br /> <br />I <br /> <br />ArfI./\l/ <br />· OTHER c.o.rr\l.L)L <br /> <br />MARK <br /> <br />o BENCH <br /> <br />o QUARTER CORNER <br /> <br />o SECTION .CORNER <br /> <br />N/A <br /> <br />lYPE Of MONUMENT: <br /> <br />1. <br />2. <br /> <br />FOUND: <br /> <br />DESCRIPTION OF MONUMENT <br /> <br />I <br /> <br />BY YOU TO PERPETUATE 1HE LOCATION Of THIS POINT: <br />A 2.4/1 LOAJG- ~ 5" RfiSJ\K <br /> <br />MONUMENT ESTABLISHED <br />AUAM I tV VIM c.A P <br /> <br />DESCRIPTION OF <br />'SIT :)' /4" <br /> <br />3. <br /> <br />I <br /> <br />C!N <br /> <br />SKETCH SHOWING RELATIVE LOCATION OF MONUMENT. ACCESSORIES AND REFERENCE POINTS STATING <br />WHETHER FOUND OR SET. SHOW SUPPORTING AND/OR CONTRADICTORY EVIDENCE WHERE APPUCABLE: <br /> <br />4. <br /> <br />I <br /> <br />:; T,EE POST <J <br />wI AL~MltJ'^'" . 't\' <- <br />DISC. I..S 14010 "fb \" <br /> <br />~ <br /> <br />)(. <br /> <br />l <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />Signatu,../Oate throUllh $eol <br />--F c'1 \AI . G i:!1. p.li. <br />INDEX REF NUWBER ;;n ' e- <br />y.8 <br />C T. --R---. P.li. <br />UNTY INDEX REF NUWBBR <br />.. To 1M ... aaI7 for ._.Me lHa&.d 011 _I" am. <br />R"',~ <br /> <br />CERTIFICATION <br />This II to ce;:tvde that 1_ in reaponfible ch0fge of the <br />surveying wo scribed in thitl ~ and that to the <br />beet of my knowledge the Infonnatlon presented herein <br />18 true and comlCt. <br />Name (Plea" Print): <br />Firm ~me:....I <br />Firm Addr...: <br /> <br /> <br />5. <br /> <br />N.T.S. <br /> <br /> <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />LOCATION DIAGRAM <br />1" ... i Mile <br /> <br />6. <br /> <br />Stamping on Cap <br />o..t. of neld WorIc to &lob/loh, R__ or Rehablltole <br />Wonument: <br />Dent ....~ _ uMd o. Co <br />.... flD In)' <br /> <br />Q. <br /> <br />b. <br /> <br />I <br /> <br />E' <br />+ + N <br />+ + I <br /> <br />COpy <br /> <br />I <br /> <br />I <br /> <br />'l1a: COUH'l'r CURl[ <br /> <br />COt11m' <br /> <br />or <br /> <br />AT omcz <br /> <br />. - L.ocotlon of <br /> <br />SEC_' <br /> <br />COUN'l'Y', <br /> <br />SE <br />CO <br /> <br />7. <br /> <br />..S. <br /> <br /> <br />ItIlCZM:D <br /> <br /> <br /> <br />BY:.... <br />1).Aft: <br /> <br />I <br /> <br />I <br /> <br />I <br />