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e , <br /> Agreement to Conduct Permitting by Electronic Means <br /> Name of permittee representative desiring to p / <br /> opt in to ePermit: ft/UGK15 X EQua2 iyii 6rr.cve( PAt <br /> Title: <br /> OW n¢r <br /> Name of permittee: <br /> .,4 le�da .�c)N lei ✓era. <br /> Signature: <br /> ePermitting Administrator(if different from }ac�' - <br /> representative signing agreement) Lo r�rZ 6 <br /> ��Vey-Gv <br /> Email Address for ePermit Account: <br /> Notarized Affidavit of Signature <br /> STATE OF: ) <br /> COUNTY OF: ) ss. <br /> The foregoing instrument was acknowledged &--, <br /> before me this day of aL ,'j emkj-, (�gol Z by <br /> ^"! � <br /> (date) (month) (year) <br /> as <br /> �'LL ll/�E. cT-- C? e-v--- <br /> (Name of permittee representative) (title) -- / <br /> of A 1/oll-a's <br /> (permittee) <br /> NOTARY PUBLIC <br /> (seal) <br /> My Commission expires: <br /> Page 3 of 6 <br />