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Agreement to Conduct Permitting by Electronic Means <br /> Name of permittee representative desiring to <br /> opt in to ePermit: J K L 2 + )4 0 <br /> Title: E-5 D 6,0T <br /> Name of permittee: S� - k k? S f'j-v L f d!- jkt C <br /> Signature: / <br /> ePermitting Administrator(if different om <br /> representative signing agreement) <br /> Email Address for ePermit Account: ' <br /> De- K C 5 n S0 ),dg 4-ed<. r) St. c-ovy) <br /> Notarized Affidavit of Sianature <br /> STATE OF: ) <br /> COUNTY OF: ) ss. <br /> The foregoing instrument was acknowledged <br /> before me this J T}� day of , • I C. by <br /> (date) (month) (year) <br /> as <br /> (Name of permittee representative) (title) <br /> of <br /> Co Vt S C+ <br /> °0�-T OFFICIAL SEAL (permittee) <br /> JENNIFER SALAZAR <br /> NOTARY PUBLIC-STATE OF NEW MEXICO <br /> My commission expires: H/I <br /> NOTARY PUBLIC <br /> (seal) <br /> My Commission expires: <br /> Page 3 of 6 <br />