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HomeMy WebLinkAboutbocc.con.016.1993 "y. ;:` i i , i.^ . , � ��� � � � t � r�. -� J -`'� � �-. � �ri. ,; .. � ti ' ,J ' { Z. �- . ,. .y7)„ `+�! ��Sb ',�� J� �►��������� A'.�' y '�/�ry,�j`�; ll3�� . tj?-!���.i y�A T 1 4�.:�� A ��^��)-� 5 • �Y�F L�� . - ..1'.. .�AS . w� ��� C. IgV�:-�y�' ,� .-: �?4'� �A��l'1'.i, ' . ..�i h1��;7�� .,a.�'�i':�� . .,i"=N�sM•' j,� �4�� f Lff � . . . ......_ ... . A.:��:�.'��t'�'' �i.. .. . / /T�/�ti`c d�n19G�f��� Qisr `��;� .�; �js��sr l/,g�c<�y �os�.r�c � ��,'.' �_� ,�.".,' � �" i � i ..����.".i�_7., _ C�3-/� ` , :� ` _ GRANT OF LICENSE/PERMIT �` ,� ,^__ ? jlw:[i.' .:" - a�,. The undersigned, representing the Board of County Commissioners : i;r,_ . „ ,�..' o£ Pitkin County, Colorado, dqes hereby grant a Iicense to the ^ }�` w i;.:�: S;�:i above named applicant to provide ambulance service within Pitkin �;;': ; f.; . . !' County. This license shall have upon it any restrzctions listed ; � 1 �'�` �;:�� below, shall be granted any waivers listed below, and shall be - , .,k..�': i valid for the dates listed below, unless revoked by the Board i pursuant to the provisions of Resolution No,. 8?-7 F:: � � � RESTRICTIONS• . I ��� � � .� � ` f �• _.�__� WAIVERS GRRNTED: � i ,i .\ ,' t _ i ; ,�. THIS LICENSE IS VALID FROM/UNTIL:Januarv 1 1993 until Decemher 'il_ 19e3, . �'.r �: ;. �.::; j ± � , -- r � �+ DATE• CH IRMAN, BOARD OF COUNTY COMMISSIONERS �;; ' 1_�:..: S, .....__.._�__...W..,..:.. _ � . . -__ _ _ ..._� ..._..:,._......._._ .._.__..._ _ , __ .._ � _. .___ _ __ C'�:. : � � ' - v ,±�'�:. - r . t���, . ;F,> 3,� ;� � (�:��>� ,.� � � �;�r. .r, �r .. � .`.� ;�: ,�.'._ -..:.. 1�� ..:4i �� .. r V. {J ��Y � i �I �;�/ . i� !�t�S . . . . �l � y�'�6' M � . � �T Yr�ief'.� 1 r � 'K� j �"� , � a..: Alar�+�?'i '�,�,' . @�y��r� �,' � � • « . . ��' tl ' 4te . . yY;--. . �, � ��� i ,r. i;.. � Y. 4. �''6!�' ,. �. J�i.� �. ^ X �Y�.. .: .���.. � .. .�. . , n y -.. �!n a , , . � ;�- , . -;�.- .. � �-..� ...e,r: ��y��� ' i� ' . : ""NVTM�`. . . '��.�ii � '� :::ti,.F�' � , - . _.... .,.��Zt: '� "' .,�L=l C � �1� t''�. � � '" �;;y:.�.' ' i, ;�.. . - i�;i. i.,.'�: PITRIN COUNTY APPLICATION FOR APIBULANCE LICENSE '�' 'f' � :.;;�;r: - C:.+:'H. 1:-.i �, _ PLEASE TYPE ALL INFORMATION SERVICE NAME: -RSp�y -�M�v1.q�f��,tlltrr�cr (�c 1 VA �-+ l�L'�S�itn1_ '�'�' . .. �;'�Y`9 ' ADDRESS: C��o{ CASTir CtZt-r�c �►L �c'�n) .,�_ 'r ' OWNERS OR OEFTCERS: � �I .�..� � K I PHONE NUMBERS: �z-S— �Z a I ! LICENSE NO. ��'�.7 ; DESCRIPTION OF AMBULANCE: MAKE, MODEL, YEAR, � . � ° F / r . �9$� r�2� VA� `�'CT ��W�JNNJ,1 � FOi�-53�1_j FF{hZ57_S� .�. . W �.;, . � KCAVV 9,oa��t �` . ADDRESS AND DESCRIPTION OF BASE OF OPERATIONS: � � —�s7�1 V�l!F-+. I�otp�riat_ �:,�>e 1 '��r• PHYSICIAN ADVISOR: t z COLORADO CERTIFICATION NUMBER: 8�81 Colo ; I PHONE NUNIDERS: �l L — �, ' . � --I SIGNATURE: d, ; WAIVER REQUES S: �o �� `•� :� �. . � - f � � '� � '� F� ; Jl 4 .�. �� 1 ��y�� j .S:_� � APPLICANT: TZi u�Arra-+1- l./�aL�c�z 1 DATE: 4 tI z-3�L- '�, � l i SIGNATCTRE: � � L✓� ` � � �, , i i . j ;���; � `::;}}�;; �_:,�:.:.;,:., ; �. .,......._--.___--_._ ___ _._ ...._.� I , � _.. _ _ ..__ _. . l ��: 1, ,, ' , � , �;.�:�,'�, • , ��,';?,e: , . - ;A,?�