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COLORADO DEPARTMENT OF TRANSPORTATION Please print or type <br /> UTILITY/SPECIAL USE PERMIT APPLICATION <br /> Instructions: <br /> Complete this form,attach all required documents,and submit it to the appropriate permit office.To determine which documents are required, <br /> refer to page 2 of this form and/or contact the Permit Office.You must submit all required documents or the application will be deemed to <br /> be incomplete and will not be accepted. <br /> Permittee: property or utility owner <br /> Name Martin Marietta Materials, Riverbend Sand and Gravel <br /> Address <br /> 1627 Cole Blvd, Lakewood Co.80401 <br /> Contact person Steve Gordy email address Steve.gordy@martinmarietta Telephone <br /> 919-268-9350 <br /> Applicant if other than permittee <br /> Name <br /> Address <br /> Contact person e-mail address Telephone <br /> Activity Description: (furnished by permittee) <br /> Purpose of Utility Permit <br /> Installation ❑Adjust/relocation ❑Removal ❑Maintenance of existing facility ❑SUE/Other <br /> Facility/Utility(type,size,Gass of transmittant,design pressure or potential,etc. <br /> Conveyor Bridge Over US 85 near Fort Upton M.P. 238.6 US 85 <br /> Nature of installation ❑ Longitudinal (parallel) ❑ Buried* 0 Aerial/Ground-mounted <br /> Transverse (crossing) ❑ Attach to Highway Structure #: <br /> Purpose if for other than Utility Permit <br /> ❑ Landscaping ❑ Survey ❑ Spill cleanup ❑ Site restoration <br /> ❑ Construction within right-of-way [E Other (describe): Transport material accross highway <br /> State Highway No. County Cityfrown <br /> US85 Weld Fort Upton <br /> Location relative to SH milepost(s) <br /> 238.6 <br /> Location relative to intersecting feature(s),e.g.,cross street,str.#,etc. <br /> Approx 1/2 mile north of CR6 <br /> Intended start date and planned duration of work <br /> April 1, 2019 <br /> Additional remarks <br /> If Permittee will own or operate underground facilities in State Highway rights-of-way:Indicate contact person for Telephone <br /> underground location information: <br /> Russell Brynjulson Plant Mgr Riverbend SSG 303-410-5744 <br /> *Notice to Excavators: Pursuant to 9-1.5-103 C.R.S., excavators shall not make or begin any excavation without first notify- <br /> ing the Utility Notification Center of Colorado (UNCC) and if necessary, then notifying the tier two members having under- <br /> ground facilities in the area of such excavation. Notification shall also be given to the CDOT regional permitting office, or as <br /> otherwise directed by the Special Provisions of the permit that is issued. Notice of the commencement, extent and duration <br /> of the excavation work shall be given at least two business days prior thereto, not including the day of actual notice. The <br /> UNCC may be called at 1-800-922-1987. See reverse side for additional instructions. <br /> Previous editions of this form are obsolete and may not be used. Page 1 of 4 COOT Form#1233 111116 <br />