PERMFILE114116

• Permit No: M1980193
• IBM Index Class Name: Permit File
• Doc Name: LIMITED IMPACT 110 & SPECIAL TEN DAY 111 PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

Check One
PURCHASE ORDER
E1 Paso County
DEPARTMENT OF PUBLIC WORKS
_ 3170 Century, Colo. Spgs., Colo. 80907
yeller ~/?VIUE 7'N/E~qn/
~ddre
1 ~ ~s N. GCJL a RaJ 04 , ~OS33
Gravel
Water
Soil C]
Other
NUMBER O `~D~ 3
Dated JAS d a- _ _1g 80
Refer to the above number or
provide a copy of this order
with any claim you may find
necessary to file.
declare that I am o~+~mer of the real property wherein ~RAt/Et
•xists and is located in Township ~ ~ (s), Range 6 O W,
ection o7 Quarter $LJ The Deaartment of
ublic Works may purchase from me, Gle,vC! in the quantity
stimated below, during the period .1A.tr ~1 /9fa to include
Jdnr ~ 1 iv ri subject to the following Special Provisions:
If none this will be so noted hereon). ~'a~ av ..~u Sco,vc /Zga.,eS
T~ 4~ / SGnf ~riUN)1~LJr! /J/_~~,v/nc_- pLci,[611 a.~~PM SE'E~~ /-v
l2t SEES.
nit of
easure
~~~~
Approx. No.
of Units
Cost
Per Unit
~ o ~•
~~r~)
ayments to be made monthly by Warrants issued by EL Paso County based upon
tie number of units purchased during prior month.
~~~{/tfif0 ~~~l~%yZf.E%/4Ci~lJ
(Signature of Seller)
irchase Order Acquired by V~
ignature
U,•l~ ~~
Titl
(Purchasing Agent)
~-7 ---- ,~ ~~ ~
irchase Order Approved by /~~'~a ~ ~ i~ 7'_ ~~. , .
M.ax L., ,Rot schild, P.E.
Director of Public Worka/County Enginee ~~