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NOTARY FOR STRUCTURE OWNER WITHIN 200 FT OF 5 MILE PIT AFFECTED AREA <br /> ACKNOWLEGED BY: <br /> Structure Owner V Name <br /> Date 1 'C? - f Title_ L ` rE � <br /> I ► t�iiaA►K r — , <br /> � I <br /> NO <br /> STATE OF erg <br /> SS. NOTARY ID20174DW765 <br /> COUNTY OF My COMMISSION EXPIRES 01106/2021 <br /> The foregoing was acknowledged before me this day of L'. 20 by <br /> CI <br /> ` f.as <br /> My Commission Expires: 01 01� <br /> Notary Public �— <br />