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.. n0. G-~ <br /> <br />• <br />• <br />COLORADd DEPARTMENT OF TRANSPORTATION ~a ~~ <br />~ bwirgaulhodryappacadon <br />STATE HIGHWAY ACCESS PERMIT A ICAI~ON <br />`~~ a"~P'~,°~~'. <br />Inswcllons: -Contact the Colorado DeparlmenlWTrensportaG O't)or eminent tenruneyoura;auirig authariy. <br />• ContaM theissuing autnodryl0 detenNne what ill Bother are req hesubndhed vrith yourappaWOon. <br />• Complete this loan (soma quespans may not apply u)arMa cry anteantl SuDmlt ltto Ute lsstdng authodry. <br />Pease print -Submp an application for each etxess affected. ~ <br />i <br />r <br />0i type - If you have any quesaons contact the issuing authori <br />b <br />- Foraddi6onal lnfamatbn see CDOTsAccess Menape peat <br />1)Properryovrner (Permtitae) ~ fdlffarem ran properlyowner) <br />8hi1 Wol£ LSC Transportatio Consultants, Inc. <br />SUeetaddress ~ paddress <br />p. p. Box 16804 1889 York Street <br />City, state & zip Ptanei coy, state 6 u9p Ptarlep(requlretg <br />Golden, CO 80401 3D3-931-9096 Denver, CO 80206 303-333-1105 <br />Ernatl address Email address ff avalbble <br /> aja@lecdentrer, coin <br />3) Atltlress of property to Deserved Dy permit (regWred) <br />N/A <br />4) Legal description of property: If vAthh iurlsdicgorral Omits of Munldpaliry, olryarvl/orCounry, wAUch one? <br />ram1Y suaaWbn abd bl rroaon IormYrp r <br />Gilpin N/A 9E1/49ec 26 T39 R92N <br />5)Wlbt StateHlphwayare you requesting accessfrom9 8)Whet efdeo}thehl way! <br />Sfl 119 QN ~S ^ E ~ W <br />~Howmanyteafbthe proposed access fromihe nearest rape post? Now marry testis theproposad access from) atreareat voss aUeet7 <br />0 feet []N S^E from: Mp 1.3 teat N^3^E ~ f . <br />8) What Is the epproxlmate date you Intend W Depin consprugion4 <br />8/1/2005 <br />9) Chedchaa If you are requasWg e: <br />l~^ <br />i(newaccess ^temporeryaccass(dure OnUdpated: ) Qlmprovemant <br />chan <br />e in access use removal of access ocaUon of exbtingaccess <br />eaistln <br />aoeess ( <br />roNd <br />detain <br />J <br />l <br />g g <br />p <br />e <br />10) Provide e>JstUlgproperryuss <br />Surface alining/One Residence <br />1t)DO You have knovaedpeaflary Slate HlghweY access perMte serving thispropedy, oradjacent propertiesthwQU you haves property Ugarest7 <br />©ra Qyes,ify~-what areUlepemdtnumbeu(s)andprovidaaples: No. 103039 8 100 52 anNOr,permlttlate: <br />12)DOesmepropa ownerown or have anylntaresbin any adiacmltpropergR <br />©no ~. yes, If yea • please desGibe: <br />13)lve plere other exbUnp ordaNeated puWlo streets,roads, Nphways Dresses easements bordering orvApdn the roperty! <br />no ['lyes, p yes • Ust them on your plans and Indlnste the prgmsed end ealsling access pdnta <br />14} If you are requeat7ng agdculiurel ffefd access- law manyeaes w& me aocess serve9 <br />tb~ltyou are requesting commerdal orlndustriel access please lndtcefethetypes end number of quslrresses endp ethe8oorarea square footage of each. <br />bU51ne5sAerM aSe 9(plarefoofape bttsirless ~ 6quafe footage <br />Surface Mining 500 acres <br /> <br />t~lfydu are equesdng reaWardiel developementaassa, what isthelype(slnple fenllly, apartrnent, townhouse) number of unas7 <br />Type numDerof rusts type number ofunlb <br />1 residence <br /> <br />1~ Proves the foUovAng vehlclo count estimates fa vetddas tlwt wilt use the eases. Leaving the property Then reW "nil is aso comb. <br />tomcats if your counts ere a a p••r^^a•r ua ad sera wn. a pok eour+aa•w a a u ual 4urkr a v.a n•m vaunu <br />• eakhourvWlarlesor©everepedaltyvolumes. 30 20 <br />•a Wills Wl wMNa In •ss a90a aof lam resin lraO NWPTr^4 TOtel unt Of 811 vehicles <br /> 5 <br />Pravlaus Batons era obtolW and may not ba used ~ Papa 1 uI Z CDO~ iorm x137 7Lea <br />