2019-09-04_REVISION - M2008022

• Permit No: M2008022
• IBM Index Class Name: Revision
• Doc Date: 9/4/2019
• Doc Name: Decision Date Extension Request
• From: Oldcastle SW Group, Inc dba United Companies
• To: DRMS
• Type & Sequence: SO1
• Email Name: ACY
• Email Name: THM
• Media Type: D
• Archive: No

NOTARY FOR STRUCTURE OWNER WITHIN 200 FT OF 5 MILE PIT AFFECTED AREA
i
ACKNOWLEGED BY: j
Structure Owner Name
Date Title
STATE OF
)ss.
COUNTY OF )
The foregoing was acknowledged before me this day of ,20 ,by
as of
My Commission Expires:
Notary Public