_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

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PURCHASE ORDER NUMBER
El Paso County 63/a /
DEPARTMENT OF PUBLIC WORKS
3170 Century, Colo. Spgs. , Colo. 80907 T
alley �r/P i+/Q �c Dated << 1 ZJ 19
9dress l Refer to the above number or
t
(
provide a copy of this order with any claim you may find
necessar to file.
declare that I am owner of the real roperty wherein.. i
Gists and is located in Township _(s) , Range Id"O W,
°ction / Quarter N The Department of
iblic Works may purchase from me, in the vuantity
:timated below, during the period &.,eAzts1 v1J / -J to include
) / sybject to the , llo ing Special Provisio
:f . ne this 'wi 1 b • noted hereon) . . 'zp ns:. , or
ti•
.it of Approx. No. Cost
:asure of Units Per Unit
yments to be made monthly by Warrants issued by El Paso County based upon
e number of units purchased during prior month.
(Signatua of Seller)
rchase Order Acauired by e C�
Signature
F �o
Title
(Purchasing Agent) +
-chase Order Approved by
Max L. Rothschild, P.E.
Director of Public Works/County Engineer