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~' ~ ~ ~ L <br />R 6 8 Form. / 201 ` ~ ~ ~ ~' <br />Copy Distribution <br />1-Applicant Road District /1~~ ~ _ <br />i-000n [y Commissioners County Road M v-^.~-/~f-l~y2~ <br />1-Road 6 Bridge Office County Fermat d / <br />1-Road District Foreman <br />San Niguel County <br />Road s Bridge Department <br />~/1 Anpplication for Special Construction Permit <br />'///:N/N6 ((J. !herein called "Applicant") hereby request5 per- <br />mtssion end authority frcvn the County Commissioners for a Special Construction <br />Permit, which will entail disturbance of Che County Road and Right-af-Way only <br />in the area and to the extent herein described. <br />Applicant sulmits harewi th for the consideration and approval of [he County <br />Commissioners, [heir agents and employees, a sketch or blueprint of the proposed <br />disruption, showing all necessary specifications and dctall, as en attached perc <br />of this application. <br />The Applicant binds end oDligetes hLnselt to perform Bald work in concurrence <br />with the Resolution 1978-69, as passed and adopted on June 19, 1978 during a reg- <br />ular meeting hg10 in Che County Courthouse, in Telluride, Colorado. <br />TAe Applicant, In submitting this application to which his signature is at- <br />tached, signifies that he is full aware of the conditions con Catned in the above <br />resolution, and that he will at all times abide by those conditions. <br />The Applicant understands that no work may commence un [il Che necessary ap- <br />proval is gi van, end [ha necessary bond has been pasted with the County. <br />~ / 8~ <br />Date of Application <br />~m.,M~:,.,,, ~o. <br />Address Hof Applicant <br />tS(cq''Id/~ <br />Telephone <br />Signature <br />Special Conditions <br />To be filled in by San Niguel County <br />See Attached <br />Permit granted this 30th day of June 1986, subject [o the <br />provisions, specifications, end conditions stipulated hereto: <br />ROAD 6 BRIDGB DEPARTNENT ' BOARD OF CO <br />U <br />NTY COMMISSIONERS <br />ey: / <br />/ <br />By~(~, /C~~~ <br />R ed Super isor CAalrmen <br />NOTE TO APPLIGNT: This permit shall be made available at the site where and when <br />work is being done. <br />Bond Amoun^_ <br />Date Posed <br />Type of Bond <br />Bonding Ccvnpany <br />Capy received by_ _ _ __ _ _ _ - __ _ _ <br />a~ <br />