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COLORADO DEPARTMENT OF TRANSPORTATION Issuing authority application <br /> STATE HIGHWAY ACCESS PERMIT APPLICATION a�P�ncedate: <br /> Instructions: -Contact the Colorado Department of Transportallon(CDO�or your local govemment to determine your issuing authority. <br /> -Contact the issuing authoriry to determine what plans and other documents are required to be submitted with your application. <br /> - Compiete this form(some questions may not apply to you)and attach all necessary documenis and Submit R to the issuing authority. <br /> PI@8S@ pflllt - Submit an application for each access affected. <br /> O��rpg - If you have any questions contact the issuing authority. <br /> - For addftional information see CDOTs Access Management website at httqs://www.codotqov/business/oertn itslaccessDertnits <br /> 1)Property owner(Permittee) 2)Applicant or Agent for permittee('rf different from property owner) <br /> Gary Knippa <br /> Street address Mailing address <br /> 33084 Bergen Mountain Road <br /> City,state&zip Phone# Ciry,state 8 zip Phone#(required) <br /> Evergreen, CO 80439 720-412-8838 <br /> E-mail address E-mail address'rf availabie <br /> gknippa@msn.com <br /> 3)Address of property to be served by permit(required) <br /> Address NA Access Opposite Rd23A <br /> 4)Legal description of property:If within jurisdictlonal limits of Municipality,city and/or County,which one? <br /> counry subdivfsion blxk lot section towr5hip ranpe <br /> Lake <br /> 5)What State Highway are you requesting access from? 6)What side of the h' hway? <br /> US24 �■ N �S � E �W <br /> 7)How many feet is the proposed access from the nearest mile posY? How many feet is the proposed access from the nearest cross street? <br /> mm 178.15 feet N S�E from: right 0 feet N QS❑E from: CR 23 <br /> 8)What is the approximate date you intend to begin construction? <br /> 9)Check here'rf you are requesting a: <br /> �new access Qtemporary access(duration anticipated: ) �improvement to existing access <br /> �change in access use �removal of access �ebcation of an existing access(provide detail) <br /> 10)Provide existing property use <br /> Slag material storage <br /> 11)Do you have knowledge of any State Highway access permits serving this property,or adjacent properties in which you have a property interest? <br /> ano ❑yes,if yes-what are the permit number(s)and provide copies: and/or,permk date: <br /> 12)Does the property owner own or have any interests in any adjacent property? <br /> ❑no �yes,'rf yes-please describe: <br /> 13)Are there other existing or dedicated public streets,roads,highways or access easements bordering or within the property? <br /> �no �yes,if yes-list them on your plans and indicate the proposed and existing access points. <br /> 14)If you are requesting agricultural field access-how many acres will the access serve? <br /> 15)If you are requesting commercial or industrial access please indicate the types and number of businesses and provide the floor area square footage of each. <br /> busi�ss/land use squaze footage business square footage <br /> Aggregate material supplier 100,OOOTtyr <br /> 16)If you are requesting residential developement access,what is the type(single family,apartment,townhouse)and number of unfts? <br /> type number of units type number of unRs <br /> 17)Provide the folbwing vehicle count estimates for vehicles that wili use the access.Leaving the property then retuming is rivo counts. <br /> Indicate if your counts are �o���e�cars and ii�n�m,c�s ac Peaic nour�owmes ff of mulU unft trucks at peak hour volumes <br /> . ak hour volumes or Qaverage daily volumes. 4 <br /> 1 of sirple und vehides in excess of 30 ft. •of fartn vehicles(field equipment) TOtAI COUflt O}811 Ve111C1@9 <br /> 4 8 <br /> Prevbus editlons are obsolete and may not be used Page 1 of 2 CDOT Form#�137 12N 8 <br />