Souder, Miller

Souder, Miller St. Associates Engancering • Environmental Surveying George A. 'Herrera, P.E. Senior Transportation Design Manager 2904 Rodeo Park Drive tall. Iluikling IC0 Santa Fe, NM 87505 fax cell www.soudermillercom • EFTA01124434 NM7,01 New Mexico Department of Transportation Environmental Development Section P.O. Box 1149 Santa Fe, NM 87504-1149 SURVEY PERMISSION FORM Date: /1.- /2 NMDOT Project Control Number: f/DO 115 Project Scope: x4 4/ Hive 074 4 /../ Scope of Survey: pedestrian (walking) survey for cultural and biological resources. The survey does not involve collection or excavation of pa resources. i))11 '614 - W f y -Cov "-/ General Property Description: .7o g4,4%. #1( it6 Parcel Number(s): Number Owner's): Name Address: Address CityStateZip CYffri f/ in` , 4A t-I100 006FAr.c F d 5+4411)NM g to I HEREBY GRANT PERMISSION TO THE CONSULTANT/CONTRACTOR REPRESENTING THE NEW MEXICO DEPARTMENT OF TRANSPORTATION TO ENTER UPON THE LAND UNDER MY OWNERSHIP OR CONTROL TO PERFORM CULTURAL AND BIOLOGICAL RESOURCE SURVEYS IN CONNECTION WITH THE ABOVE REFERENCED PROJECT. IT IS AGREED THAT THE STATE WILL PAY FAIR MARKET VALUE FOR ANY DAMAGE DONE TO THE LAND. Owner Signature Date Printed Owner's Name: Telephone Number: CONDITIONS UNDER WHICH PERMISSION IS GRANTED: CONTACT INFORMATION: Adam Miera, P.E., NMDOT Project Development Engineer Phone: Email: EFTA01124435