2017-01-19_GENERAL DOCUMENTS - M2012018

• Permit No: M2012018
• IBM Index Class Name: General Documents
• Doc Date: 1/19/2017
• Doc Name: Agreement to Conduct Permitting by Electronic Means
• From: Stone Canyon Quarry LLC
• To: DRMS
• Email Name: AME
• Email Name: SLB
• Media Type: D
• Archive: No

Agreement to Conduct Permitting by Electronic Means
Name of permittee representative desiring to {
opt in to ePermit:
Title.
Name of permittee:
Signature:
ePermitting Administrator (if different from
representative signing agreement)
Email Address for ePermit Account:
Notarized Affidavit of Signature
STATE OF:
Co l /-,Oo
COUNTY OF: uU/04/ ) ss.
�o ►--
The foregoing instrument was acknowledged
before me this J day of
(date)
as
(Name of permittee representative) (title)
E
RENA MEDINAlic - State ill Col]2020
ID 2015403281on Expnr.ti �N„ 7
(sea!)
My Commission expires:
n�a
(month)
of
(permittee)
�'4,P 4/) CA
NO ARY PUBLIC
Page 3 of 6
by
(year)