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Agreement to Conduct Permitting by Electronic Means <br /> Name of permittee representative desiring to <br /> opt in to ePermit: /f -����� eks, <br /> Name of permittee: / 11 r )1c,n b Ria,5t <br /> Title: <br /> rf-Mn6q_i0 <br /> Signature: <br /> Email Address for ePermit Account: a n t,b i Q S,-, no I. ccm <br /> Notarized Affidavit of Signature <br /> STATE OF: <br /> (1_610 ) <br /> COUNTY OF: ) ss. <br /> LAS An irn 4s <br /> The foregoing instrument was acknowledged • <br /> before me this `��n 4-1day of /pri ' 24/100by <br /> (date) (year) <br /> as <br /> nneunn ipn <br /> (Name of permittee representative) (title) <br /> of <br /> ni (L' nronr.) L'n-kairpriLses <br /> (permittee) <br /> 4„1, / / _L / <br /> N I ARY PUBLIC <br /> (seal) <br /> My Commission expires: <br /> Page 3 of 4 <br />