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
DEPARTMENT OF
3170 Century, Colo.
County
PUBLIC WORKS
Spgs., Colo. 80907
yeller ~ ~ ~ ~ -~ ~~ ~~....~~
r~
address ( - ,~ ~'~

Gravel
Water
Soil []
Other
NUMBER
3 y/ri
Dated ~ - ~ -~ ' 19_'
Refer to the above number or
provide a cony of this order
with any claim you may find
necessary to file.
declare that I am owner of the real property wherein ~~~~ /
•xists and is located in Township /f (s), Range ~~~ W,
ection // Quarter/• The Department of
ublic Works may purchase from me, l:~-•... in the quantity
stimated below, during the period ;~_ a~ - to include
--f 7 / subject to the following Special Provisions:
if^none this wild be so noted herepn). ,~~%- ~ -. ~ ?
~ r
nit of
easure
~'
Approx. No.
of Units
~(,1..~•~-n....v
Cost
Per Unit
/o d

ayments to be made monthly by Warrants issued by E1 Paso County based upon
Y.
~rchase Order Approved by ~/t-`-r' y /~ ~~~~ ~-y~
Max L. ~tot`~ischild, P.E.
Director of Public Worka/County Engineer