2016-02-17_GENERAL DOCUMENTS - M1998091

• Permit No: M1998091
• IBM Index Class Name: GENERAL DOCUMENTS
• Doc Date: 2/17/2016
• Doc Name: Agreement to Conduct Permitting by Electronic Means
• From: Joseph & Arlene Cogan
• To: DRMS
• Media Type: D
• Archive: No

Agreement to Conduct Permitting by Electronic Means /
OM- 6A:te jfbitAi'd
Name of permittee representative desiring to
opt in to ePer nit:
Name of pennittee:
Title:
Signature:
Email Address for ePermit Account.
STATE OF:
COUNTY OF:
Notarized ffida 't of Si _nature
The foregoing instrun Zit was acknowledged
before me this
(Name of permittee representative)
(seal)
My Commission expires:
ss.
day of
(date)
as
(year)
by
(title)
of
(per nittee)
Page 3 of 4
NOTARY PUBLIC