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San ru5u~' Cat:ntu "~9'iJ-:'_r-1C90 -- -- uo: ~C o:~5 tJO.OCd F.Ot <br />III'lllll'IIIIII III <br />sss <br />R8B Form •201 (Revised 6198) Pape 1 <br />Dopy Dtetributlon Permit K dot U[ <br />1 ' Appllcertt County Rostl r <br />I -Board of Canty Cornmiuione^s Rvad District • <br />'I -Road Department <br />1 -Road Dbtrict 6nop <br />Appifr:atlon fbI itxnahl Conetruotlw+ Pernik <br />t;an Iltlyu« Ceurgy Roan Deparhrrnt <br />PO Oax ~ <br />Herweed 00 !1~ <br />Tet (i70) i27~Yii Pax pI0) ~27dOta0 <br />Applloant: ?Ieree odnt er Woe <br />,y-~ ~ ~T)NC .~. 7"ar~ <br />Name <br />i~0~ i~~.v 1~~ <br />{Address <br />Ky. ~, IJp <br />x]70- 677- ~7~7 <br />Telephone Number <br />`~7~ X77- ~,9~/ <br />Fax <br />-11-a~-cd <br />Contactor Performing Work <br />(tt dMtererA then AAplkenq <br />Dau of AppLCahon <br />Applicant hereby roquesb psrmisgon and auttxxify hom the County Commissioners for a Special <br />Construction Pemtit, whbh will ental tllatur'oanoa b the County Rned and npht-ot-way only in the area and <br />:o the extent herein dasonoed. <br />Applicant s~lxnib herawiGn for the wnaaerafion Of the approval o! the County Comrrusaioners, 'heir agents <br />end employees, a plan or proRM of the propaaed diarupfbn, showing all necessary specifx:ahone and <br />detail, sa an attached pert of tn~a applicetton. <br />The Applicant agrees b perform ttq w0tk in canpYanq 1YIth San Miguel County Resvlut:on 1996-23 as <br />paasad and adopied an May 28, 1gg6 during a rbputar tnaetinp held Ir: the Miromonte Building, m TatJur~ve. <br />Cdoredo. <br />fAX TO: FAX d No. of pages _$ <br /> <br />