PERMFILE100867

• Permit No: M1979148
• IBM Index Class Name: Permit File
• Doc Date: 8/10/1979
• Doc Name: LIMITED IMPACT 110 & SPECIAL 10 DAY 111 PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

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• The O~.mcr hereby uarran is that he has good title to the above described pre= ~
m is es; tha [. he has the lawful right [o grant [his Op[ton, and [hat he agrees [o

hold the Department iia nnl css from any and all .la ims from others asserting any '
interest in the subject land.
Additi.onaL Conditions See Atta~:hmen[ dl •~ ,
e
Alarik H rin
DEPARTMENF OF HIGHWAYS, STATE OF COLORADO ~
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(Owner(s) - Insert as appcar(s ~
above))
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Isv: 1~~.~,.~.~ ,u,C~: ~~..~~ ev: '
Wa yn 11. Robinson, Nigli~:iay Eng incer L Alarik Nyrin~ ~~:
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UISTRIAUTLON: ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ '
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' Orig Lnal - Design -cnoincer ~ '~ ~ ~ ~ ~ ~
_
1 - Ounet or each Owner ~ ~ ~ ~ ~ -
1 - Materials Engineer - Denver ~ :. ~ ~ - ~ ~ ~~ ~° -
2 - Construction Engineer - District ~ ~ .~ ~ ~ ~ .
L - Maintenance Engineer for all State Forces Projects
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. STATE OF
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COUNTY OF (A~?7`.~.r~.l )
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day of . ~ ~
foregoing instrument was acknowledged before me this ~
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MLtness Ry hand and offi
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i al seal,
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My cotvsi ssion expires ~J^. ~-. ~•~~ /9 S ~
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(SEAL) ~ Notary PublLe

(Original to be acknowledged and recorded if, Ln the opinion of the District ,
Engineer, there is possibility of transfer of the premises or question of title.
Ref es .to D, O. M. Memo No. 418, dated April 7, 1972.) ~ ~ ~

~~ Please attach plat of pit area. .. ., ., . '

Field Sample tio. ~ ~ ~ ~ ~ ~ ... ~ i
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