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HomeMy WebLinkAboutbocc.con.017.1993 ���,��,�e� t 1,,� ..,... � *:�y r � /- a r���,;: � �: r rt� .� .��a31tr� '�^ � � 1.� p ' +L�t n , ,�� ���'_ 3 5�•� ' yt .;ri S�'i��€}! . �s5�`�e6<: aK �' �' t a fi�,�,,�y�, ���, '' '-{' ' �� x 'ci�i i' r[i.� - ,�F, �i . 3. �ic ,�,"i�,F �:dyk v,r L'r.� �i,i i _y�1 _, � °" .• ::F _ . r .�� .. . . . _ . . '�ti":.�;#41'�:!. w .A � ,�isT ''� > �s�£n l��nr��.�� � �°t:;`.�`'z�. �-- �SI�'�ik !/'�<'La'� �S�'/T•fL �Iy''.;;,�. .j�. }'��:� . .. i'.'�.r:'- f � . ��,3'-�7 � r^ . GRANT OF LICENSE/PERMIT `��'�`�;�� The undersigned, representing the Board of County Commissioners *'� of Pitkin County, Colorado, does hexeby grant a license to the ,'3 jabove named applicant to provide ambulance service within Pitkin � t �';. , � County. This license shall have upon it any restrictions listed ;..� � below, shall be granted any waa.vers listed below, and shall be . ��- k3;-; • valid for the dates listed below, unless revoked by the Board ! . pursuant to the provisions of Resoluti�n No,. 87-? f:.` j RESTRICTIONS: ; q'� 1 '���' � � � S I WAIVERS GRANTED• _ --; i 4 . I ca '� t .'\ w \ 1 � 1 �. - i THIS LTCENSE IS VALID FROM/UNTIL:Januaty 1 1993 vntil December 37. 199�, � '}. �M v #�, i I � - f � � � DATE- -"` � � � CHAIRMAN, BOARD OF COUNTY COATMZSSIOPJERS `' 'I' :; i � , f;, ,..., _ _- _------- -- _ _.. .._..... �:�::.._,�.-- __..,____._._ ._. _ .,._ „ __ ` . __ __ _. . ._ . i • ti- � � - ., � r ��3: , %`,5;�i . , '#�: ;a�i � , ^'}�'+Fi � s. .1. t � . r „r -�'� ' t i7 t.' � r _ ' ::,� .:. .. n S. U Jv > ". �..Yi��.. w � 1� � r. . r , »� �,. �-. ' � . . . � ,�,rt �Y�l���'S ,'K� ���y• . . . . . ��' N�: wx � .f t 1 . .. 'k'Y.y .. _ � . .i 3 . '�{ �'�'�' .`.:-'i»��St: � �f �,'�.5. �,Y4C,.�.� t i .��_ . i: _ . �'�. . iitl�a�,�7.��si . .._ . �;�4,��j'�.'• ��. . .�� . • -- �- M- ac. - irYa' -�', . . ' 7: A. ' ' J � ...._ .';y"r.. .":,': '.�4_. _... . I..'�.�,�,.. PITKIN COUNTY APPLICATION FOR AMBULANCE LICENSE f � �.�,.:r,:. � PLEASE TYPE ALL INFORMATION ,,� _ . 's . �.`+' .`.. . j SERVICE NAME: (�S�E±t � �xu nic� ��S�ta.+cr'—�c.! �nl�c-� z.'»t�aL y:a:� i —� 7�.. j ADDRESS: E��-1-o� f A�r Ccic-sr�� �vs. -ti4ss,}6+J �';;�j � �>.. .' . . OWNERS OR OFFICERS: !&;: . 1 i � ! ' PHONE NUMBF�ZS: �1 t�i- �1 Lo "��k � DESCRTPTION OF AMBULADICE: MAKE, MODEL, YEAR, LICENSE NO. •�t;': . i f I � ! ���-a F.c�.x�VArJ -N,or,��,..�,� '•�od� 03'!z." �)7 R� H�I�t99��. • � AADRESS AND DESCRIPTION OF BASE OF OPERATIONS: �. � -�,�c� �A\,V:.,i ts�o s�..;-,.� �';i� _,'-� , PHYSICIAN ADVISOR: ! COLORADQ CERTIFICATION NUMHER: , Colo �S � � PHONE NUMBERS: '�. L o . _,_� SIGNATURE: � WAIVER REQUESTS: n��, `i \ + , ` � ; , I , _; l?. I �.` w-:. ; , §�;,_ ! - �: = APPLICANT: 1Z�u.�.4c_,_�-4�,_� DATE: lt�i,3�q, •i � t ' � :�..,/ I � STGNATURE:� �J ,�1/,,,r_o/ , �, � � ' t i ; 7r. . i x": i,,.,;; � i � .... �..:�;:_ � � .:.:•.-,.:. _:.�_:..,.. �.:.... ..:.. . . -....:... . � • . . .� - .�_�t:,�:. . . ..;_.._ -.._�. ....� - ...�..� . .. . .. . ' . . . � , . . . .. .: .�. �, i .. . ' � . . � . . i � . ' � ���,. . . t1�Sz,"^4' - � _ _ , . �Y