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Agreement to Conduct Permitting by Electronic Means <br /> DEC2i ��t� <br /> DMSION <br /> Name of permittee representative desiring to MININ6AND <br /> opt in to ePermit: Cjc �� 'W A <br /> Title: Q _A€ <br /> Name of permittee: MQR40W 4- 4y10i41/kiL <br /> Signature: <br /> ePermitting Administrator(if different from <br /> representative signing agreement) <br /> Email Address for ePermit Account: <br /> NJ <br /> Notarized Affidavit of Signature <br /> STATE OF: <br /> COUNTY OF: �r�� � ) ss. <br /> The foregoing instrument was acknowledged l��h � ,�� � '�.1 <br /> before me this — dayof by <br /> (date) (month) (year) <br /> as <br /> rep 11 ed <br /> (ITma ee of permittee representative) (title) orat)d <br /> of &CqPil 6�ZJ At� <br /> (permittee) <br /> RUSSELLJONES <br /> 1 Iotary Public-State of Colorado <br /> Notary ID 20094029270 <br /> My Commission Expires Sep 10,2021 NOTARY P IC <br /> (seal) <br /> My Commission expires: <br /> Page 3 of 6 <br />