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Weld County Public Works Dept. <br /> 1961 1111 H Street <br /> P.O.sox75s ACCESS PERMIT <br /> Greeley,CO 80632 APPLICATION FORM <br /> G O u y T Y Phone: (970)304-6496 <br /> Fax:(970)304-6497 <br /> Property Owner Authorized Anent/Applicant(if different from Owner) <br /> Name Cliff Simpson Name <br /> Company C&H Aggregates Company <br /> Address 43646 CR 45 Address <br /> City Ault state CO ziP 80610 City state Zip <br /> Phone 970-834-2247 Phone <br /> E-mail cliff@chexcavation.com E-mail <br /> Information Proposed Access Information <br /> The access is on CR 94 Culvert size&type(W CMP/RCP min.) 151,CMP <br /> Nearest intersection:CR 37 &CR 94 Materials used to construct access ABC Class 5 <br /> Distance from intersection: 1258 ft. Access construction schedule 03/15/21 -5/15/21 <br /> Parcel number:055107000003 Approx.width of access 40' <br /> Sectlon/Township/Range:7/$N/65W <br /> Proposed Access Count Existing Access Count <br /> Total number of existing accesses to parceko Residential 0 Residential 0 <br /> Total number of proposed accesses:1 Commercial 1 Commercial 0 <br /> Latitude 40.6714 Longitude-104.713$ 0 0 <br /> Oil and Gas Oil and Gas <br /> Pianning/building case number Agricultural 0 Agricultural 0 <br /> Description of Work Temporary 0 <br /> Access will be used as an enterance into the Pierce Pit mine. <br /> Required Attached Documents <br /> Property map or sketch(template available on pg.2)indicating all proposed and existing accesses <br /> Access Pictures(N,S.E,&W at the location where the access meets a county maintained road) <br /> Access Authorization Form(Not required if the application is signed by the property owner) <br /> Additional application materials may be required by the Public Works Department <br /> Fee schedule <br /> $150-Temporary,Small Commercial&Residential <br /> $300•Industrial&Large Commercial <br /> Submit application to accesspermits@weldgov.cam <br /> By accepting this permit the undersigned Property Owner/Authorized Agent.under penalty of perjury.✓errhes they hasp received All pages of the permit asrplirahnn;they <br /> have reap and under Stand all the pNmit r uirements and prinnslons set form on all pages.By nr toe of their signature the aroperry Ownw/Awhorlted Agent is hound by <br /> and agrees to tom ly wiIf�id permit requirements and prov,uons,all weld County ortimances,mid state laws regarding Artois tpnstr,�ttinn, <br /> 110116/ <br /> Signature Printed Name Cliff Simpson Date 3/312021 <br /> Signature Printed Name Date <br /> Iln uu.a mn'.npM p,nMrty nrror¢/aulMn,wA 4enrvt,i <br /> Accesses must be constructed within 1 year of issuance.An extension an be requested from the Weld County Public Works Department. <br /> Accesses must be in accordance to Chapter 12.Article V and Appendix 12-A of County Code <br /> Page 1 of 2 <br />