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`tlt`~lcb Y.2CettleG('10~•f.-CuJ~KcCw~sa <br />COLORADO DEPARTMENT OF TRANSPORTATION ,L3 9~ Issuingauthoriryappl lion <br />JTiaTE HIGHWAY ACCESS PER APF~.ICA~ N axeptanceeate: ~.,_ <br />InsWCtions: -Contact the Colorado Department of Tr ortadon yourloce vemment to determine your issutngauthority. "'-"- <br />- Contact the Issuing autlrorily to detertni ghat p documer re required to be sufxnitted with your applipgon. <br />- Complete this form (some questions m of apply to~OR! attach al essary documents and Submit g to the issuing authority. <br />~ <br />S@ print - Submit an applfnatfon for each aocess a ed. ` <br />t <br />or type - If you have any questlons tooted the iss tt$author <br />~ <br />- Foradddional ktfortnatbn see CDOTsA nagement websd <br />1) Property owner (Pertnittee) pertnittee (g different from property owner) <br />Phil Wolf C Transportation Consultants, Inc. <br />Street address Mailing address <br />P.O. Box 16804 '~ 1889 York Street <br />City, slate & zip Phone # Cfry, state 8 zip Phone # (required) <br />Golden, CO 80401 303-931-9096 Denver, CO 80206 303-333-1105 <br />E-mall adtlress E-rtlall address if available <br /> aja@lscdenver.com <br />3) Address otproperty to be served by permit (required) <br />N/A <br />~4) Legal description of property: If within jurisdictional limits of Municipality, eiry and/or County, which one? <br />G lpin SN/AID a~ ~a SEl/4Sec 26 3T S~ 7~ <br />S) What State Highway are you requesting access from? 6) What side of the h way? <br />SH 119 ~N ~S ©E ~ W <br />7) How many feet is the proposed axes from the nearest mile post? How many feet is the proposed access from the nearest cross street? <br />0 feetaN SSE W)from: MP 1.3 feet N^S^E^ from: <br />6) What Ls the approximate date you intend to begin constmcgon7 <br />6/1/2005 <br />9 Check here ff you are requesting a: <br />new axes ^temporary access (duredon anticipated: ) ^knprovement to existing access <br />ge in access use Qremoval of access Q~ relocatbn of an existng axes (provide detalp <br />10) Provide existing property use <br />Surface Mining/One Residence <br />11) Do you have knowledge of arty State Highway access permits serving this property, or adJacent properties in which you have a property interest? <br />~no Dyes, if yes-what are the permd number(s) and Drovide copies: No . 103039 S 100052 and/or, pennfitlate: <br />12) Does the props owner own or have any interests in any adjacent properly? <br />~no ~ yes, 'dyes -please describe: <br />13) Ara there other existing or dedicated public streets, roads, highways ar axes easements bordervtg or within the propert7/t <br />~] no ~ yes, if yes - list them on your plans and Indicate Ne proposed and existng access points. <br />t 4) g you era requesting agriwkural field axes -how many acres will the access serve? <br />15) H 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 />businessAand use square footage business square footage <br />Surface Mining 500 acres <br /> <br />,19) {f you are requesting residential deveWpement axes, what is the type (single family, apartment, townhouse) and number of units? <br />type number of units type number of units <br />. l residence <br /> <br />I ; Quids the togowing vehicle count estimates for vehicles that wdl use the access. Leaving the property then retumkg is two counts. <br />~; to if your mounts are ~ d passenger can antl rghl trucks at peak her vaumes ~ tl mule ,mn trucks m peak hour vdumm <br />eak hour volumes or Qaverege dairy volumes. 15 10 <br />~~ a Skye vnk vehidn m .arse tl ao s. r tl ram, ~ohidae (read eswpmem) Total count of all vehl _ EXFIIBI7 <br /> 25 <br /> II <br />Previous etl(dons are obsolete antl may not be used Page 1 <br />