2022-10-28_REVISION - M2018027

• Permit No: M2018027
• IBM Index Class Name: Revision
• Doc Date: 10/28/2022
• Doc Name: Request for Technical Revision
• From: Civil Resources, LLC
• To: DRMS
• Type & Sequence: TR2
• Email Name: ECS
• Email Name: MAC
• Email Name: AWA
• Media Type: D
• Archive: No

DocuSign Envelope ID:A3839651-094E-48D2-872A-CD6D1A8820BC
COLORADO DEPARTMENT OF TRANSPORTATION
UTILITY PERMIT
PERMITTEE APPLICANT DEPARTMENT USE ONLY
Name: David Hunt Name: Date Issued: 09/21/2022
REP: David Hunt REP:Kyle Regan Permit# 4220522 Milepost(s) Side(s)
Address: Address: S.H.# 085 254.000 Left&Right
14460 WCR 40
Region:4
Platteville,Colorado 80651
Email: [e-mail] Email: [e-mail] S.H.Section:C
Telephone:[phone] Telephone: Patrol: 16 Platteville
NOTICE TO PERMITTEE:For underground facility location information,contact the Utility Notification Center of Colorado(UNCC).Pursuant to 9-1.5-103 C.R.S.you shall
not make or begin excavation without first notifying the UNCC and if necessary,then notifying the tier two members having underground facilities in the area of such
excavation. Notification shall also be given to the CDOT regional permitting office, or as otherwise directed by this Permit's Special Provisions. Notice of the
commencement,extent and duration of the excavation work shall be given at least two business days prior thereto,not including the day of actual notice. The UNCC
ACTIVITY DESCRIPTION Furnished by Permittee
PURPOSE ® Installation ❑Adjustment ❑ Removal ❑ Relocation ❑SUE/Other ❑ Maintenance of Existing Facility
FACILITY (Type,size,class of transmittant,design pressure or etc.) 30"steel casing pipe and install a 24"HDPE water line
DESCRIPTION OF WORK:Bore a 30"steel casing pipe and install a 24"HDPE water line under SH-85 approximately.4 miles south of the intersection
with SH-60
NATURE OF INSTALLATION:❑ Longitudinal ®Transverse(Crossing) ® Buried ❑Aerial/Ground-mounted
LOCATION:approximately 3230 feet south of mile marker 254
County:Weld County City/Town:Platteville
ADDITIONAL REMARKS:
SPF.CIAI,PROVISIONS(completed by the Department) The Special Provisions are terms and conditions of this permit.
Any work shall only be in accordance with the approved plans and special provisions as set forth in this permit and its attachments.
The CDOT inspector is Don Michalik Telephone: [phone]
Inspector Email:[e-mail]
Work is to be completed on or before:01/19/2023 or within 120 days,(as applicable)
Work time restrictions: Daylight Hours.
Designated minimum cover is 4.5 FT Designated overhead clearance is 24 FT
(ALSO SEE ATTACHED STANDARD PROVISIONS,AND ADDITIONAL SPECIAL PROVISIONS), (TRAFFIC CONTROL MUST CONFORM TO THE MUTCD)
Other:
Permittee is prohibited from commencing any work within highway ROW prior to issuance of a fully endorsed and validated permit. Permit,plan
exhibit,insurance certificate(s),and traffic control plan must be available on site during work. High visibility vests are required at all times during
working hours.
1. Your request to use and/or occupy state highway system rights of way as described above is granted subject to the terms and conditions of this permit,including
the Standard and Special Provisions as shown on the permit and all attachments hereto.
2. To the extent authorized by law,Permittee hereby assumes,releases and agrees to indemnify,defend,protect,and save the State of Colorado harmless from and
against any loss and/or damages to the property of the State of Colorado,third parties or the Permittee's facilities,and all loss and/or damage on account of injury
to or death of any person whomsoever,arising at any time,caused by or growing out of the occupation of Colorado State Highway rights of way by Permittee's
facilities or any part thereof,including but not limited to installation,adjustment,relocation,maintenance or operation,or removal of existing facilities,unless such
loss and/or damage arises from the sole negligence or willful conduct of the State of Colorado or its employees or agents.
3. Failure by the Permittee to comply with any of the included terms or conditions may subject this permit to suspension or cancellation,at the discretion of the
Department of Transportation.
4. THIS PERMIT IS NOT VALID UNTIL FULLY ENDORSED BY ALL PARTIES,WITH DATE OF ISSUE AFFIXED BY AN AUTHORIZED REPRESENTATIVE OF THE DEPARTMENT. A
FULLY EXECUTED COPY OF THIS PERMIT MUST BE ON FILE AT THE TRANSPORTATION REGION OFFICE.
5. In accepting this permit the undersigned,representing the Permittee,verifies that he or she has the authority to sign for and bind the Permittee,and that he or she
has read,understands and accepts all the included conditions.
CDOT Signature: Date Permittee Signature Date
DocuSigned by: DocuSigned by:
9/22/2022 1 1:33 PM MDT �gq5 55 p, 9/22/2022 1 1:28 PM MDT
4co.Fa4 nni IVanle/Mile
6�L8kADO DEPARTMENT OF TRANSPORTATION
Chief Engineer, Regional Transportation Director or Designee David Hunt David Hunt manager
Distribution: Region File(Original) Mtce Landscaping Supvr
Permittee/Applicant Inspector CDOT Form#0333 01 09
Mtce Patrol Supvr. Previous versions are obsolete and should not be used.