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VlAgreement to Conduct Permittin b Electronic Means g Y <br /> f� �� <br /> Name of permittee representative desiring to <br /> opt in to ePermit: I Ly IF- 1_ <br /> Name of permittee: 1j\IT-'F-kkJ ATro <br /> Title: <br /> Signature: l_ <br /> Email Address for ePermit Account: U Pau S (e - - C(n . cmn <br /> Notarized Affidavit of Signature <br /> STATE OF: nn ) <br /> I..DLOPA-L C� <br /> COUNTY OF: ) ss. <br /> The foregoing instrument was acknowledged aQ� <br /> before me this 0 day of by <br /> (date) (year) <br /> �Ll.ST►t� L�l tJ� as 0-O D Z P L.AuT AAA t J A G ce <br /> (Name of permittee representative) (title) <br /> of ,/ <br /> SNAL� - 14.c!-t �uT�RI�IA-�►t�t.lA1. �cRJtcES <br /> (permittee) L-�-c- <br /> NOTARY PUBLIC <br /> LW'Lt A�J nw3j S idn NOISSIiH m m <br /> (seal) BmomL ai A2N10N <br /> My Commission expires: n /�/ Oa wo i00:10 31VIS <br /> OZ / / onend AW10N <br /> A3.WIS HN33a <br /> Page 3 of 4 <br />