PERMFILE47333

• Permit No: M2004067
• IBM Index Class Name: Permit File
• Doc Date: 11/21/2005
• Doc Name: Exhibit 206
• From: City of Black Hawk
• To: DMG
• Media Type: D
• Archive: No

State Highway Access Permit
• Attachment to Permit No. 105070 -Additional Terms and Conditions
1. A Notice to Proceed, COOT Form 1265, is required before beginning construct on of the access or any activity
in COOT Right-of--Way, Ail submittals, documents, plans and other items that ust be completed, shall be
submitted and approved before a Notice to Proceed for construction wilt be iss cd. Contact the Department
for the Notice to Proceed.
2. If there are any questions regarding this permit, please contact Anna Welch,
303-75?-9126.
3. Incorporated as part of this permit will be the following:
Application for Access Permit (COOT Form No. 137)
The Permit (COOT Form 101) and its two page attachment (COOT Form
Notice to Proceed
Certification Letter
Construction Plans
Signing and Striping Plans
Drawings/Maps
Certificate of Insurance (To be submitted to COOT prior to beginning constr
4, This permit is issued iu accordance with the State Highway Access Code (2 t
upon the information submitted by the Permittee. This permit is only for the
Access Manager, at
in COOT Right-of--Way)
601-1), and is based in part
and purpose stated in the
Application and Permit. Any changes in the traffic volumes or type, drainage, other operational aspects
may render this permit void, requiring a new permit to be applied for based up existing and anticipated
• future conditions.
S. If necessary, minor changes, corrections, and/or additions to this permit maybe rdered by the Department
inspector, other Department representives or local authority to meet unanticipa d site conditions. Changes
may not be in violation of the Code.
6. Left turn movements in and out of this access may be prohibited at some future te.
7. This access shall be used only for commercialfresidential purposes with the veh ular volume using the access
during the Peak Hour not to exceed 50 vehicles per hour,
8. This Access Permit is issued for tFje entire property shown on "Exhibit A". F division of these parcels
into smaller parcels will require all future parcels to use this access point only. o future access points will be
granted from these parcels, or portions of these parcels, onto State Highway 119 because of division of
ownership.
9. All other accesses to the property shall be removed immediately. Removal shat include, but not be limited to,
the return of the highway tight-of--way side slopes, ditches and fences to match xisting adjacent conditions,
including removal of the asphalt aprons. Any asphalt removed from the highwa shall result in a smooth
finished edge. The area shall be covered with a minimum of 4 inches of top soil and re-seeded accardmg to
the Department's speciftcations for grass seed mix.
10. The Permittee is responsible for obtaining any necessary additional federal, star ,and/or city/county permits m
clearances required for constniction of the access. Approval of this Access Pe it does not constitute
verification of this action by the Pemtittee.
11. The Permittee shall provide the Department and !or the issuing authority with th following information prior
to commencement of any construction activities beyond the existing curb and ter or paved area, within