_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
Check One Water
Soil
Other
PURCHASE ORDER NUMBER
El Paso County 3 y///
DEPARTMENT OF PUBLIC WORKS
3170 Century, Colo. Spgs. , Colo. 80907
f
r-
;eller J// 4i Dated -) 19 ' '
address ( v ,� �' _ Refer to the above number or
provide a copy of this order
i.• , � ; 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 /�z (s) , Range W,
>ection // Quarter /. The Deoartment of
'ublic Works may purchase from me, in the quantity
!stimated below, during the period a .- 7 to include
^ - f i/ , subject to the following Special Provisions :
If none this will, be so noted herepn) . • ' - ?
( 1
snit of Approx. No. Cost
leasure of Units Per Unit
1 ,
,
l
ayments to be made monthly by Warrants issued by El Paso County based upon
he number of units purchased during prior onth.
(Signature eller
urchase Order Acauired
// Signature
Tiltl�
(Purchasing Agent)
Y
urchase Order Approved by
Max L. Jto schild, P.E.
Director of Public Works/County Engineer