2019-10-11_REVISION - M2008022

• Permit No: M2008022
• IBM Index Class Name: REVISION
• Doc Date: 10/11/2019
• Doc Name: Completeness Response
• From: Greg Lewicki & Assoc.
• To: DRMS
• Email Name: ACY
• Media Type: D
• Archive: No

I NOTARY FOR STRUCTURE OWNER WITHIN 200 FT OF 5 MILE PIT AFFECTED AREA
ACKNOWLEGED BY:
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
I
I