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:Se_. Mfgue' County Tc~97G-327-1090 <br />RA6 Form 11201 (Revised 6198) <br />Copy DbMbutbn <br />1 - Applloattt <br />1 - Board of County Commisaiortaro <br />1 -Road Dapartmem <br />1 -Road DlsMet 6YtOp <br />Idov 23~C 935 Nop.0~04 P.BO~1 <br />` a~! ad~' <br />~~~, <br />Apptteatlon TOT tlPet:lal CotaAnratlort Pennll <br />Nn 1NOOal Ceungr Read Dapartnrne <br />PO colt ~ <br />Pape 1 <br />Partnit• 0-1~~ - <br />Counly Road +~ <br />Road Dlafrkt • <br />Re~e1ved <br />APR /~ 9 20~ <br />Mareod (A H~ <br />TOI (NO) it1•~K pat (qti! Sifr0~0 Oivis~uraR9o F;el <br />Applleant: Plena erlnt ar t,ena <br /> <br />Name <br />~ D • i~ o~ /le ~, <br />Addrou <br />C ~reG ~n . 813 ~,~{ <br />City. State, 2Ip <br />9~0- 6~7- ~~r?~ <br />TeNphone Number <br />~7D - X77- ~,9~.i <br />Fex <br />D,oa of Appl~catlon <br />(If d~lerer~it than App tk~n~~ R o/M~eeryJd$ G~~N <br />Applicant hereby requests psrrniselon and au8grity Tram the County Commisaionsn for a Special <br />Conebuetion Pemtit, which wil er~i dlattJrbanOa b the County Road ono nght~fway only in tha aroa and <br />to the extant herein described. <br />Applk~nt a~~bmlts herawiGh br the consideratlon oT iM appr9val of Uw County Commsaroners, they agents <br />antl employees, a plan or proNN of tln ProDOMd dMruptlon, showing all necessary spe0dicaGone and <br />detail, n an atlaehed part at thie appllcatbn. <br />Ths Applicant agrees b perform the wOAt in oompfanq with San Miguel County Rseolubon 1998.13 as <br />passed and adoDbd on Mey 28, 1tTQ0 during a nspular rtate8rtp helo h tna Minmonte Building, in Tallun0a, <br />Cdorseo. <br />!'1N( TO: PA7( ~ <br />No. of pages ,4 <br /> <br />