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Agreement to Conduct Permitting by Electronic Means <br /> Name of permittee representative desiring to / <br /> opt in to ePermit: �Gt vc 01 <br /> Title: O �� <br /> Name of permittee: I 1 n 1 a <br /> Signature: <br /> /. <br /> ePermitting Administrator(if different from <br /> representative signing agreement) <br /> Email Address for ePermit Account: �Gt GZ 1 r-P-a I$`@ Q nka I , cO,-�, <br /> Notarized Affidavit of Si nature <br /> STATE OF: A l ) <br /> COUNTY OF: ) ss. <br /> cV- <br /> The foregoing instrument was a knowledged <br /> before me this Z(9`�' day of bI,i, ZO I by <br /> (date) (month) (year) <br /> Zt Vc.I I"� I I (�CL� as I <br /> (Name of permittee representative) (title) <br /> of -?atAJ <br /> (permittee) <br /> KAREN E,HOUGHT N NOTARY PUBLIC <br /> COUNTY OF ��- : STATE OF NOTARY P LIC <br /> ALBANY ',i y WYOMING <br /> MY COMMISSION EXPIRES AUGUST 2,2022 <br /> (seal) <br /> My Commission expires: <br /> Z 2� <br /> Page 3 of 6 <br />