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RECEI � . <br /> Agreement to Conduct Permitting b Electronic Means MAR 15 2016 <br /> g g y �.(� <br /> MINING AND <br /> Name of permittee representative desiring to ------ <br /> opt in to ePermit: <br /> Title: i <br /> Name of permittee: ` <br /> Signature: <br /> ePermitting Administrator(if different from <br /> tf <br /> representative signing agreement) <br /> Email Address for ePermit Account- C.Y-, r r ro C-CD ji-I <br /> Notarized Affidavit of Signature <br /> STATE OF: ) <br /> COUNTY OF: ) ss. <br /> The foregoing instrument was acknowledged <br /> before me this �-), day of by <br /> (date) (month) (year) <br /> J <br /> AS cG gust-+ V t (-C PP--0-D1 DC-ti.-r <br /> (Name of permittee representative) (title) <br /> of <br /> (permittee) <br /> 4LC 5"—U. <br /> NOTARY PUBLIC <br /> LORI SMALL <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20144046944 <br /> (seal) MY COMMISSION EXPIRES 1-2-2019 <br /> My Commission expires: <br /> PaI?e 3 of 6 <br />