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18)Check with the issuing authority to determine which of the following documents are required to complete the review of your application. <br /> a) Property map indicating other access,bordering roads and streets. e) Subdivision,zoning,or development plan. <br /> b) Highway and driveway plan profile. f) Proposed access design. <br /> c) Drainage plan showing impact to the highway right-of-way. g) Parcel and ownership maps including easements. <br /> d) Map and letters detailing utility locations before and after h) Traffic studies. <br /> development in and along the right-of-way. i) Proof of ownership. <br /> 1- It is the applicant's responsibility to contact appropriate agencies and obtain all environmental clearances that apply <br /> to their activities. Such clearances may include Corps of Engineers 404 Permits or Colorado Discharge Permit System <br /> permits, or ecological, archeological, historical or cultural resource clearances. The CDOT Environmental Clearances <br /> Information Summary presents contact information for agencies administering certain clearances, information about <br /> prohibited discharges, and may be obtained from Regional CDOT Utility/Special Use Permit offices or accessed via the <br /> CDOT Planning/Construction-Environmental-Guidance webpage http://www.dot.state.co.us/environmental/Forms.asp. <br /> 2- All workers within the State Highway right of way shall comply with their employer's safety and health policies/ <br /> procedures, and all applicable U.S. Occupational Safety and Health Administration (OSHA) regulations - including, but not <br /> limited to the applicable sections of 29 CFR Part 1910 - Occupational Safety and Health Standards and 29 CFR Part 1926 <br /> - Safety and Health Regulations for Construction. <br /> Personal protective equipment (e.g. head protection, footwear, high visibility apparel, safety glasses, hearing protection, <br /> respirators, gloves, etc.) shall be worn as appropriate for the work being performed, and as specified in regulation. At a <br /> minimum, all workers in the State Highway right of way, except when in their vehicles, shall wear the following personal <br /> protective equipment: High visibility apparel as specified in the Traffic Control provisions of the documentation <br /> accompanying the Notice to Proceed related to this permit (at a minimum, ANSI/ISEA 107-1999, class 2); head protection <br /> that complies with the ANSI Z89.1-1997 standard; and at all construction sites or whenever there is danger of injury to <br /> feet, workers shall comply with OSHA's PPE requirements for foot protection per 29 CFR 1910.136, 1926.95, and <br /> 1926.96. If required, such footwear shall meet the requirements of ANSI Z41-1999. <br /> Where any of the above-referenced ANSI standards have been revised, the most recent version of the standard shall <br /> apply. <br /> 3- The Permittee is responsible for complying with the Revised Guidelines that have been adopted by the Access Board <br /> under the American Disabilities Act (ADA). These guidelines define traversable slope requirements and prescribe the <br /> use of a defined pattern of truncated domes as detectable warnings at street crossings. The new Standards Plans and <br /> can be found on the Design and Construction Project Support web page at: <br /> <http://www.dot.state.co.us/DesicinSupport/>, then click on Design Bulletins. <br /> If an access permit is issued to you, it will state the terms and conditions for its use. Any changes in the use of the <br /> permitted access not consistent with the terms and conditions listed on the permit may be considered a violation of the <br /> permit. <br /> The applicant declares under penalty of perjury in the second degree, and any other applicable state or federal <br /> laws, that all information provided on this form and submitted attachments are to the best of their knowledge <br /> true and complete. <br /> I understand receipt of an access permit does not constitute permission to start access construction work. <br /> Applicant or Agent for Permittee signature Print name Date <br /> Eca L v iN s t - 3 <br /> If the applican Is not the owner of the property, we require this application also to be signed by the property owner or <br /> their legally authorized representative (or other acceptable written evidence). This signature shall constitute agreement <br /> with this application by all owners-of-interest unless stated in writing. If a permit is issued, the property owner, In most <br /> cases, will be listed as the permittee. <br /> Property owner signature Print name Date <br /> Previous editions are obsolete and may not be used Page 2 of 2 CDOT Form#137 01/10 <br />