INSPEC25499

• Permit No: M1990106
• IBM Index Class Name: Inspection
• Doc Name: LIMITED IMPACT OPERATION 110 APPLICATION FORM
• Media Type: D
• Archive: No

DEPARTMENT OF HIGHWAYS
STAiE'Of COLORADO
DIVISION Of HIGHWAYS
DOH Form No. 1]7
Rev. September, 1961
~~ ~ OF HIGHYYA1f5.OIV. QF
6TATE of col.o. ~ISrRIC1
P. 0. BOX 536
~~~~~~~~Date o• eptance by
'~ Issuing Authority .
k,APPL1~111~0(]~LQ~DR ~1QOf(ESS PERMIT
ISTRUCTIONS: Complete this form and attach all necessary documents prior to submitting it tothe issuing authority.
~reck with the Issuing authority for what plans and other documents are required to be submitted with your application.
Contact the nearest office of the Department of Highways or your local government to determine the issuing authority.
Some questions may not apply to you. Contact the issuing authority if you have any qu>stions.
1. Applicant
Name RRK fnnctrttCtlon, inC Phone [phone]
Address P_ 0_ Rnx 376 City _Ry.P_ state
2. Property Owner Permittee)
Name .lamPC ~. R dart' E_ Kirkland Phone 4R9-3384
Address P. fl_ Rnx 3c,4, City ?jrE state
3. Address of Property to be served by Permit (if it has an address)
Baxter Road
4. Legal description of properly Subdivision ,Block ,Lot 6 R 7
Section ,Townshi~ Range ~_
5. The requested access would be located on the west side of State Highway 933 , a distance of
approximately feet Tfrom milepost .Precise location of thep rop osed access maybe
illustrated on plans or maps. The applicant expects to begin construction on or about 8-26-85 (Date).
b. Is there existing access to the propertyt Yes X No - If so, show on plan. Do other existing or dedicated public
streets, roads or highways abut the propertyt Yes _ No X List them or show on plans.
7. For commercial and industrial requests answer the following:
a. How many businesses will be served( One
b. What types of businesses will be served and what is the floor area square footage of each.
Mining, crushing and screening of aggregates
~;
8. For an agricultural field access, how many acres will the access servet n/a
9. For residential development provide type(s), e.g. detached single family, apartments, townhouses, and number of
dwelling units to be served. n/a
10. Provide an estimated tralfic count for each vehicle type that will be using this access. Leaving property then
returning is two counts. If this question is not answered, the issuing authority will make an estimate based on land
use and standard references. Please check box according to type of estimate used: -_ Average daily
average weekday peak hour other specify- annual ,
Number of passenger cars
CO lip ~~
C0 7ip 81069
Multi unit trucks
Vehicles In excess of 30 feet Farm vehicles .
Vehicles in excess of 30,000 lbs. G.V.W. 2800 Other, (specify)
11. The following documents may be required by the Issuing Authority to complete their review of the application.
Submitted plans should be no larger than 24" x 36".
(E. Highway and driveway plan and profile.
b. Complete drainage plan showing impact to the highway right-of-way.
c. Map and letters detailing utility locations before and after development in and along the right-of-way of the
highway.
d. A subdivision zoning or development plan.
e. Property map Indicating other access and abutting public roads and streets.
(. Proposed access design.
g. Parcel and/or ownership maps including easements.
h. Signing and St(ipping plans.
12. If an access permit is issued pursuant to this application. the terms and conditions of the nermit shall be based in part
upon the information provided by the applicant. Changes in tl~e use of the permitted access that are not consistent
wWt the terms and conditions of the permit or this application may be considered a violation of the permit.
~y~•,pc
THE APPLICANT HEREBY DECLARES THAT ALL INFORMATION PROVIDED ON THIS FORM AND ANY SUBMITTED
ATTACHMENT(S) FOR THE PURPO~ TAININ~G A~ /ACCESS PERMIT ARE TO THE BEST OF HIS KNOWLEDGE
CORRECT AND COMPLETE. `r/~yk/ ~/// ,,rr
SIGNATURE(X) - A• L4 /^'~iDATE 7/16/85
Relationship to property. (owner(, less ,please specify.)
Owner ~ NOTICE: Providing false information to a government
agency is punishable as perjury in the second degree, as
Since an approv d access becomes an im ortant and inte rat AMCBfalit~ IIC ble~le
RR P g P ~,~~¢~q~~et~+~{tYvRLlf~f~~appp~icanfis
not the surface rights owner o(the property, this application muptdladtkreki~tY~l by the surface rights owner or his legally
authorized representative (or other acceptable written evidence) concurring in this application. If a permit Is authorized,
the property owner will be listed as the permittee. The authorized access permit may be recorded in the county of record.
Properly Owner (x) date