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Agreement to Conduct Permitting by Electronic Means <br /> Name of permittee representative desiring to <br /> opt into ePermit: 1-25 r,- (- -1 /vetccr-b“., g <br /> Title: v <br /> ..i - <br /> Name of permittee: (y / / <br /> C .4 0-a ' o�-,'i e. l/`s�a.� <br /> Signature: 9' <br /> ----/-7/ <br /> ePermitting Administrator(if different from <br /> representative signing agreement) <br /> ht.e� ` ,Ace1 t�,.�l,4_ rJ5(-4s�►�-�r <br /> Email Address for ePermit Account: <br /> -1 SFa.. ca. us <br /> Notarized Affidavit of Signature <br /> STATE OF: ) <br /> /vr a <br /> COUNTY OF: ) ss. <br /> �o g <br /> ande <br /> The foregoing instrument was acknowledged <br /> before me this j day of 64/6 f er , ,QQ/7 by <br /> (date) (month) (year) <br /> as / y <br /> a rr-1-51 1V�,,,e.rb r c CL7lj / 'yku/N i.�1 <br /> (Name of permittee representative)D (title) ,,,f . <br /> of <br /> (permittee) <br /> UNITA ANN VANCE i/ <br /> Notary PublicloraG <br /> State ofo <br /> Notary iD N 2174039CoColora621 NOTARY PUBLIC <br /> My Commission ExpiresD9- j 2021 <br /> • <br /> (seal) <br /> My Commission expires: q, +- , <br /> 26 ca) <br /> Page 3 of 6 <br />