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Walsenburg Sand and Gravel, CO. <br />PERMIT # M- 2009 -027 <br />PROOF OF DELIVERY - Adjoining owners <br />October 25, 2013 <br />• Complete learns 1, 2, and 3. Also complete A <br />Itern 4 If 14eetricted Delivery Is desired. <br />• Print your name and address on the reverse <br />so that we can return the card to you. a by <br />• Attach this card to the back of the malipieoe, <br />or on the front If space permits. <br />D. Is d <br />1. Article Addressed to: <br />WSG- Hribar Pit <br />❑ Agent <br />t1ed)� I C. Date or oelhrery <br />different from item 1? ❑ Yes <br />hpddreas below. ❑ No <br />• Cornple#e Iterns 1, 2, and 3. Also complete <br />Item 4 K Restricted Delivery Is desired. <br />A. SOUdurs <br />X <br />E3 Agent <br />Print your name and address on the reverse <br />❑ Addressee <br />13. by (Printed Name) <br />/Y <br />C. Date of Delivery <br />so that we Can return the Card to you. <br />■ Attach this back of the maliplece, <br />or on the fro permits. <br />(Co. <br />C3 Yes <br />❑ No <br />James Hribar <br />l� <br />" <br />1187 County Road 640 <br />Ted Franciscotti <br />Walsenburg, CO 81089 <br />3 tee' <br />2455 County Road 613 <br />Walsenburg, CO 81089 <br />did <br />❑ eWess Man <br />(J Insured Man b C.O.D. <br />❑ Registered <br />❑ Insured Man <br />❑ Return Receipt for Merchandlse <br />❑ C.O.D. <br />4. Restricted Delivery? (Exfra Fee) ❑ Yes <br />❑ Yes <br />2. Ar" Jurl+btr III <br />(rTansler from sert�/ce <br />4 <br />PS Form 3811, February 2004 Domestic Return Receipt <br />PS Form 3811, Fewmary 2004 <br />Domestic Return Receipt <br />+ „ <br />• Cornple#e Iterns 1, 2, and 3. Also complete <br />Item 4 K Restricted Delivery Is desired. <br />A. SOUdurs <br />X <br />E3 Agent <br />Print your name and address on the reverse <br />❑ Addressee <br />13. by (Printed Name) <br />/Y <br />C. Date of Delivery <br />so that we Can return the Card to you. <br />■ Attach this back of the maliplece, <br />or on the fro permits. <br />Is CWW enter dtff wd from Item 1? <br />if YES, address below: <br />C3 Yes <br />❑ No <br />1. Article Addressed tot <br />l� <br />Ted Franciscotti <br />2455 County Road 613 <br />Walsenburg, CO 81089 <br />certified Man ❑ Express Matt <br />❑ Registered ❑ Return Receipt for Merchandise <br />(J Insured Man b C.O.D. <br />4. Restricted Delivery? (Extra Fee) <br />❑ Yes <br />2. Artlde�J ' °7 1`2 010 0000 285.E -46 4 <br />(hanstler�rt se�'"[ce Tabs/) <br />4 <br />PS Form 3811, February 2004 Domestic Return Receipt <br />tc8696-021+t t6AO, <br />1 <br />