_PERMIT FILE - M1980194 ‎(4)‎

• Permit No: M1980194
• IBM Index Class Name: Permit File
• Doc Name: LIMITED IMPACT 110 & SPECIAL TEN DAY 111 PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

• • Gravel K
Check One Water 13
Soil p
Other
PURCHASE ORDER NUMBER
E1 Paso County Q/,� 7 !f
DEPARTMENT OF PUBLIC WORKS
3170 Century, Colo. Spgs. , Colo. 800907
:ller / i�c� p� Dated Je'i C)a 19
ldress see Refer to the above number or
n provide a copy of this order
with any claim you may find
IYdF'))- necessary to file.
declare that I am owner of the real property wherein J�'
:ists and is located in Township // (s) , Range 60 W,
ction 27 , Quarter SE The Deoartment of
.blic Works may purchase from me, _ in the quantity
timated-1 below, during the period / to include
subject to the following So cial Provisions: _
f none this will be so noted hereon) .
Jae, 7
it of Approx. No. Cost
asure of Units Per Unit
yments to be made monthly by Warrants issued by El Paso County based uvon
e number of units purchased during prior month.
(Signature of Sel r)
Z'�rchase Order Acquired by (/
Signature
Ca? o
Title
it�' /0� -
(Purchasing Agent)
PP y� l '
-chase Order Approved b
Max L. -Rothschild, P.E.
Director of Public Works/County Engineer