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<br />\--J <br /> <br /> <br />LAND SURVEY MONUMENT RECORD <br /> <br />Depa.rlmtn.t 0/ R.gukltl1l"ll AgmcW' <br />Board 01 Registration. lor Pro/e.1riMI4l /:7Igi....en cmd ProI.nWn4l L-.d. S'I#MJe1IO'I'S <br />1560 Broad:uJclJ. StAt. 1370. DWlwer. CO 80202 <br />PIr.oM (303) 894-7788 · 1''''''. (303) 894-7790 . TDD (303) 894-Z900X833 <br /> <br />.....) <br />- <br /> <br />COLORADO <br /> <br />I <br /> <br />I <br /> <br />REPORT ONE MONUMENT ONLY ON THIS FORM - REPRODUCTION OF THIS FORM IS AUTHORIZED <br />items to be filled in by the Land Surveyor using PERNANENT BLACK LETTERING and lines which con be reproduced <br /> <br />All <br /> <br />I <br /> <br />AFtt~L- <br />OTHER c..o.rr~ <br /> <br />. <br /> <br />MARK <br /> <br />o BENCH <br /> <br />o QUARTER CORNER <br /> <br />o SECTION.CORNER <br /> <br />N/A <br /> <br />FOUND: <br /> <br />lYPE OF MONUMENT: <br /> <br />DESCRIPTION OF MONUMENT <br /> <br />1. <br />2. <br /> <br />I <br /> <br />DESCRIPTION OF MONUMENT ESTABLISHED BY YOU TO PERPETUATE THE LOCATION OF THIS POINT: <br />'SIT 3' /4" AWMltJ,^M c..AP ON A 2.4/1 LOiJ<T ltS'l<flSJ1K.. <br /> <br />3. <br /> <br />I <br /> <br />I <br /> <br />SKETCH SHOWING RELATIVE LOCAnON OF MONUMENT. ACCESSORIES AND REFERENCE POINTS STATING <br />WHETHER FOUND OR SET. SHOW SUPPORTING AND/OR CONTRADICTORY EVIDENCE WHERE APPLICABLE: <br /> <br />4. <br /> <br />I <br /> <br />10 <br /> <br />r- <br /> <br />I <br /> <br />: <br /> <br />I <br /> <br />/ if'1C.E. PoST <br />Sou'rH or 6A-tz. fbsr <br /> <br /> <br />:2.._ -nA~ <br /> <br />Si\lnoturd/Dat. thlOU9h Seal <br />-F ul kI . t1J-t.6 p.M. <br />NOEX REF NUYBER lu.S- <br />A.~ <br />-F . p.M. <br />INOEX REF NUWBER <br />10. IDODIIll\".,u 1oO.~ OD _l,. IbMe <br />Rw.OI/OO <br /> <br />CERTIFICAnON <br />lbis is to c.:::~ that I _ in rellporlSlble chCll'9' of the <br />surv.yi"'il wo .scribed in this record and that to the <br />best of my knowledge the Information p...ent.d herein <br />Is true and c:omlCt. <br />Nome (PlIO" Print):. <br />Firm Nome:. <br />Firm Ad, <br /> <br /> <br />5. <br /> <br /> <br />N.T.S. <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />LOCATION DIAGRAM <br />1 H ::: 1 Mile <br /> <br />stamping on Cap <br /> <br />Oat. of IIeId Work to Eatoblllll. RwI.... ... Rehoblllol4l <br />I.Ionurntnl: <br /> <br />Date NOnumenl woe UMd ... Control:, <br /> <br />(Do not fln III)' <br /> <br />G. <br /> <br />b. <br /> <br />I <br /> <br />E+N <br />++! <br /> <br />.. <br /> <br />6. <br /> <br />COpy <br /> <br />I <br /> <br />I <br /> <br />. . Location of Monument <br />SEC 34 T_3$ <br />COUNT'i Il~AfAI-I <br /> <br />SEe T_ <br />COUNT'i <br />.. To lie .....s <br /> <br />01111 <br /> <br />7. <br /> <br />"liS. <br /> <br />THJ: cotnl'!"f CUHIt <br />cotnm <br /> <br /> <br />_ to "" lIIH '" <br />~. ~ t~.~a-1". ...., <br />~.. ~,. ..... - - <br /> <br />or <br /> <br />Omc:l <br /> <br />AT <br /> <br />ltIlCEIVJ:D <br /> <br />BY~ <br />DAft: <br /> <br />I <br /> <br />I <br /> <br />I <br />