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COLORADO DEPARTMENT OF TRANSPORTATION <br />STATE HIGHWAY ACCESS PERMIT APPLICATION Isauinq auNority eppllratlan <br />acospbr>cedet°` <br /> <br />Inepursara: -Contact tAN Colorado l~a6nere ofTnnaportatlon(CDOT)oryourloalpownmsrerodebrtnins your kaulnp authority. <br />- Goober tlts IswYp autltarlly ro debrmine what plain and other doamisMa era required ro ba wbmebd with your applleatron. <br />- Canpbb tltu form (soma qusstlom mey nd appy b you) end attach all necsasary doamenb and Submit H to the issulrtq autltorey. <br />Plttu~ pNAft _ Subrtd en apptlatlon ror each axeae aReded. <br />p~ ~~ - Hyou haw any questlons tooted the lesusp authority. <br />- Far additlond Informatbn aea COOTe Aaess ManapemaM waMHe at <br />1) Property owner (Pemdpea) 2) ApeM for pemtitbe (HdHlereM horn property owner) <br />Street addrs~ Mdyriq addmst <br />Gly, abte 8 Phone M CHY, date 8 dP <br />1 Phons!(regWred) <br />19-39 - 790 <br />E-mei eddipe E-maY eddraea Havelbble <br />3) Address dproparty ro M erMd by psmdt (required) <br />•) Lapel aaeagtlan prepwy: HwMih pidedlaknai wreb d MuMdpdy, cHy ardlar Corey. wtecA oneT <br />Chaffee ~~ uwa a 27 145 7~W <br />~ lMtet 3bls Hghwry an you requestlrrq acwee from9 8) Vlettl aide dIM hway/ <br />^N ~S ^ E ^ W <br />7) Haw marry Asst b the pretioead aecns from the nasal ndb pwC! <br />feet N S E from: Fbw marry feet b the propoead atren from the naereet awe strset9 <br />feet N 3~E^ bom: e <br />p) NrMe b tM approdrtrab dab you kearq b e.gYt conatruWart7 <br />here Hyou ere regtrslyp e: <br />rtew aecsea afemp«ary aaos.. (duratlan errtldpabd: ) IngtovemsM ro edeltrq eooer <br />en.rrps ti.em. a» Olamawl d.ccMa. dat.datep aaase (proMds aebl~ <br />tp) Provlda.ddrp property u~ <br />„) Co you have teawAedpe d.rry Stale F9pfrxay emeee perinea eankp Mle IroPSrtY, «edfecempropxtlsa hwnloh yathaw. properly InbteaCt <br />®no Qyee, Hyee -what aro fM psmiH number(s) and proNde eoWa: end/a, penrip dab: <br />1Y) Oaw~ptopert~owner own a have ury inbresta b ury fdJeaMproPerry9 <br />rto yes, H ye. • Weave daevibe: <br />a of CR 301 and Nor f HWY 24 285 Shown on Ma <br />13) Are Htera odrr edatlrp a dadkebd puWe atreeb, roads, higttwaye ar acawe eeeemanb bordery9 xwltlen the preperty9 <br />m ~. yea, H y. -141 ttwm on your plus and irdlale tM proposed end adetlrq aaaes paYi. <br />tat Hyou w raqueatlrq egeeueural MM aeoese -how marry ease wd tlrs access esrve7 <br />/S) If you eta rsqueatlrq oomtnareW or indwbtet eooea phase hrdkab the ryPsa end ruenber dbuharaa end ptovds Uu Moor arse equate tootps death. <br />breYraeaA~d ur sgww bueyteee aquars roobpe <br />cce s it 9.9 Acre no buildin s <br /> <br />1p) ttyau ua requsstlnq taddeMlel dsvelepsmeM eeoeaa, whet to the type (eingle temiry, apertmare, townhouse) end number dutdb4 <br />type numlirdueb type numberdunib <br /> <br /> <br />17) Provide Ute folbaibq veMCb court attbttabt tar whf W tltttwkl ua tM across. LeevYq lM propeey tlten rebminq b two Dooms. <br />Indlpte M your courts <br />her vokanse ~avsrags dairy volurrres. s d pewnpw ur rn xpw suds a n~a oar vain.. a ar mus ura nor • vw taw wWw <br />ta.q. ueviva.ramrawe <br />20 aarMavM/drltwa gJprwq TtNal wuMdepvMkba <br />0 24 <br />Pravleua adltlom are oeaobb and may not M upd papa 7 d T CDOT Fame alai 13101 <br />