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<br />'wi <br /> <br />COLORADO LAND SURVEY MONUMENT RECORD <br /> <br />DtpGrlr7Mnt 01 Rep1.atOl'7l "gmoW. <br />Board 01 Registration lor Pro/eUitmGl ~_ G1ld Pro/..wmol Lcmd S1I.1"VetJO'rS <br />1660 Sroad:ulolJ. Suite 1370. Dmwr. CO 80.10.1 <br />p,- (80S) 894-7788 · Frs: (808) 894-7790 · TDD (808) 894-Z900X888 <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 PERNANZNT SLACK UTTERING ond lines which con be reproduced <br /> <br />All <br /> <br />AFttAL. <br />· OTHER COOT!l.OL <br /> <br />POINT: <br /> <br />DESCRIPTION Of MONUMENT ESTABLISHED BY YOU TO PERPETUAlE THE LOCATION Of THIS <br />\ J 1/ J <br />'SIT 3 4 AWt'\lAlV\M c..AP ON A. .2.4- I LOJJG- tt 5" RfJ5lti2.. <br /> <br />SKETCH SHOWING RELATIVE LOCATION OF MONUMENT. ACCESSORIES AND REFERENCE paINTS STATING <br />WHETHER fOUND OR SET. SHOW SUPPORTING AND/OR CONTRADICTORY EVIDENCE WHERE APPUCABLE: <br /> <br />0= ~ ~^\I... \..lIT'" M..lAMI#JIA1Yl <br />DISc.. LS 14010 IN iblJEl PoLE. , <br />o "', S\(I,f') <br /> <br />MARK <br /> <br />o BENCH <br /> <br />CORNER <br /> <br />o QUARTER <br /> <br />o SECTION CORNER <br /> <br />N./A <br /> <br />fOUND: <br /> <br />TYPE Of MONUMENT: <br /> <br />DESCRIPTION Of MONUMENT <br /> <br />4. <br /> <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br />2. <br /> <br />3. <br /> <br />g~r':~ <br />DUl <br />~ <br />~ <br />CERTIF'ICAnON <br />Thi8 . to ~ that I woe In /'ftPOMlble c:1\ar98 of the <br />.u~ng WOri'Clncn'bed in this record and that to the <br />beet of my knowl.. the InformoUon pre.ented herein <br />I. true Gild c:onwc:t. <br />Nome (Plea.. Print):, <br />Firm Norne:.... <br />Firm Add.....: <br /> <br /> <br /> <br />5. <br /> <br /> <br />l <br /> <br />N.T.S. <br /> <br />- <br /> <br />~\)~t-~ ~ <br /> <br />~~~ <br /> <br /> <br />I <br />I <br /> <br />I <br /> <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br />LOCATION DIAGRAM <br />1," ... 1 Mile <br /> <br />6. <br /> <br />Stamping on Cap <br /> <br />Date of n.td WOtic to EatobllIII. RMtoN or R.tloblltot. <br />~ <br /> <br />Date NonlltMflt _ UMd . C <br /> <br />M111ll In: <br /> <br />a. <br /> <br /> <br /> <br />b. <br /> <br /> <br />COpy <br /> <br />UCIIVI:D loT oPnCI or THI OOUJl'J'Y' CDRIt <br />OOVll'lY <br /> <br />. - Location of t.Ionument $ivnotUN/Date throll9h Seal <br />SIC \<0 ,. \ S --J C:lz. \t..l . C, tb p.M. <br /> <br />COUNTY ADI,M~ INDEX RBF ~ <br />N.3 <br />SEc ~ R . P,IL. <br />COUNTY INDEX RIP' NUMBER <br />.. To be lIM4 00IlI1 fer ..--. 10M... OD __, u.. <br />RelI.o.e,/OO <br /> <br />7. <br /> <br />..8. <br /> <br />sr~ <br />DA'l'I: <br /> <br />