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(10-08-2000) <br /> AUTHORIZED AGENT -IF DIFFERENT FROM PROPERTY OWNER(please pent) <br /> Name: <br /> Mailing Address: <br /> Phone: Office: Home: <br /> Fax: Email: <br /> ❑WRITTEN,NOTARIZED,AUTHORIZATION AND CONSENT FROM ALL PROPERTY OWNERS FOR <br /> AUTHORIZED AGENT TO ACT ON THEIR BEHALF <br /> NOTE- ALL CORRESPONDENCE REGARDING THIS APPLICATION WILL BE ADDRESSED TO THE <br /> AUTHORIZED AGENTIREPRESENTATIVE UNLESS OTHERWISE REQUESTED. <br /> SURVEYOR(please ptint) <br /> Name: Foresight West Surveying <br /> Mailing Address: 4955 Iris Street, Wheat Ridge, CO 80033 <br /> Phone: Office: 303.504.4440 ext 122 Home: NA <br /> Fax:720.519.1487 Email <br /> ENGINEER(please print) <br /> Name., Morrison Geotechnical Solutions, Inc. <br /> Mailing Address: 2745 S. Arbutus Way I Lakewood, CO 80228 USA <br /> Phone: Office: Office: 303.989.1480 Home: NA <br /> Fax: Email: <br /> PROPERTY INFORMATION <br /> Lenal Descriation of Proverty: <br /> ❑ If Subdivision,name, <br /> Lot_ Block_ Filing_ Tract <br /> if Metes and Bounds:Section 31 & 36 Township 1 5S Range cswa rowOR Attach a legal <br /> description and survey depicting the property boundary. <br /> If Mining Claim(s),include name(s)and Mineral Survey Number(s): <br /> Flotissent(USMS 8460).,Mother Lode,Red Cloud,Goftysburg,Appomatox(USMS 0717Y Hogs Eye,Oscar 0,Shira(USMS 8864); <br /> LWsa E(USMS 10600):Louisa D(USMS 12270) <br /> Street Address <br /> Assessor's Tax Parcel Identification No(s)(PID): Please See Attachment. <br /> NOTE. IF LESS THAN THE ENTIRE PROPERTY IS THE SUBJECT OF THIS APPLICATION,ALSO <br /> ATTACH A LEGAL DESCRIPTION OF THAT PORTION AFFECTED. <br /> Page 2 of 4 <br />