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t e) Check with the issuing authority to tletermine which of the following documents are required to complete the review of your applicatbn. a) Property map indicating other access, bortledng roads and streets. e) Subdivision, zonmg, or development plan. b) Highway and driveway plan profile. f) proposed access design. c) Drainage plan showing impactrothe highway rightrof-way. q) Parcel antl ownership maps including easements. tl) Map and letters detailing utility locatbns before and after h) Traffic studies. _ development In and along Me righFOf-way, ) proof of ownership. 1- It is the applicant's responsibility to contact appropriate agencies and obtain all environmental clearances that apply ro their activities. Such clearances may include Corps of Engineers 404 Permits or Colorado Discharge Permit System permits, or ecological, archeological, historical or cultural resource clearances. The CDOT Environmental Clearances Information Summary presents contact information for agencies administering certain clearances, information alwut prohibited tlischarges, and may be obtained from Regional CDOT Utility/Special Use Permit offices or accessed via the CDOT Planning/Construction-Environmental-Guidance webpage hlip•llwww dotstate co uslenvironmentailFortns aso. 2- All workers within the State Highway right of way shall comply with their employer's safety and health policies/ procedures, and ail applicable U.S. Occupational Safety and Health Administration (OSHA) regulations -including, but not limited to the applicable sections of 29 CFR Part 1910 -Occupational Safety and Health Standards and 29 CFR Part 1926 - Safety and Heath Regulations for Construction. Personal protective equipment (e.g. head protection, footwear, high visibility apparel, safety glasses, hearing protection, respirators, gloves, etc.) shall be worn as appropriate for the work being performed, and as specified in regulation. At a minimum, all workers in the State Highway right of way, except when in their vehicles, shall wear the following personal protective equipment: High visibility apparel as specified in the Traffic Control provisions of the documentation accompanying the Notice to Proceed related to this permit (at a minimum, ANSUISEA 107-1999, class 2); head protection that complies with the ANSI 289.1-1997 standard; and at off construction sites or whenever there is danger of injury to feet, workers shalt comply with OSHA's PPE requirements for foot protection per 29 CFR 1910.136, 1926.95, and 1926.96. If required, such footwear shall meet the requirements of ANSI Z41-1999. Where any of the atwve-referenced ANSI standards have been revised, the most recent version of the standard shall PIY• 3- The Permittee is responsible for complying with the Revised Guidelines that have been adopted by the Access Board under the American Disabilities Act (ADA). These guidelines define traversable slope requirements and prescribe the use of a defined pattern of truncated domes as detectable warnings at street crossings. The new Standards Plans and can be found on the Design and Construction Project Support web page at; <h~t R;//www.dot.state.eg~uslDesianSupQorf/>. then click on Design Bulletins. If an access permit is issued to you, d will state the terms and conditions for its use. Any changes in the use of the permitted access not consistent with the terms and conditions listed on the permit may be considered a violation of the permit. The applicant declares under penalty of erjury in the second degree, and any other applicable state or federal laws, that all Information provided on this form and submitted attachments are to the best of their knowledge. true and complete. 1 understand receipt of an access permit does not constitute permission to start access construction work- Applicanrs signature Print name Date ~ '~ ~ ~~ ~~~,c.~..-eRX~(9 .~~~ T- At:.,,.~ r~e.~a 3'z2~a(- 1 if the appf' nt is not the owner of she property, we require this application also to be signed by the properly owner or f their leg thor' represent ive (or other acceptable written evidence). This signature shall constitute agreement ( with thi a n by t owner -of-interest unless stated in writing, If a permit is issued, the property owner, fn most cases ~ be d as perm' ee. ~operty ersignatu a rin na e1 Date \\ Previous editions are obsolota and may not 6e used Page 2 of 2 CDOT Form At77 iZ