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
ACKNOWLEGED BY:
4
Structure Owner Name V� .
J h e V.
Date 7—2 3-- ! Title o �A-k r-
STATE OF C�c It ) TA NO NOTARY Pus F�LE
\ ) ss. STATE OF COLORADO
COUNTY OF`\ NOTARY ID#19974014077
My Commission Expires August 24,2021
The foregoing was acknowledged before me this ' day of - , 20 14 , by
as of
My Commission Expires: A-
Notary P lic