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18) Check with the issuing authority to determine which of the following doaments are required to complete the review of yourapplicetion. <br />a) Property map indice8ng other access, bordedng roads end streets. e) Subdivision, zoning, ardevelopmentplan. <br />b) Highway and ddveway plan profile. f) Proposed access design. <br />c) Drelnege plan shaving impad to the higttweydgM-af-way. g) Parcel and ownership maps induding easements. <br />d) Map and letters detaiNng u81Ny loce8ans beforo and after h) Treflfc studies. <br />development in and along the dgM-of-way. ) Proof of ownership. <br />1- It is the applicant's responsibility to contact appropriate agencies and obtain all environmental clearances that apply <br />to their activities. Such clearances may include Corps of Engineers 404 Permits or Colorado Discharge Permit System <br />permits, or ecological, archeological, historical or cultural resource clearances. The CDOT Environmental Clearances <br />Information Summary presents contact information far agencies administering certain clearances, information about <br />prohibited discharges, and may be obtained from Regional CDOT Utility/Special Use Permit offices or accessed via the <br />CDOT Planning/Construction-Environmental-Guidance webpage hf~:/lwww.dot.state.co.ua/environmental/Forms.asp. <br />2- All workers within the State Highway right of way shall comply with their employer's safety and health policies! ` <br />procedures, and all applicable U.S. Occupational Safety and Health Administration (OSHA) regulations= including, but not <br />limited to the applicable sections of 29 CFR Part 1910 -Occupational Safety and Health Standards and 29 CFR Part 1926 <br />- Safety and Health Regulations for Construction. <br />Personal protective equipment (e.g. head protection, footwear, high visibility apparel, safety glasses, hearing protection, <br />respirators, gloves, etc.) shall be wom as appropriate for the work being performed, and as specified in regulation. At a <br />minimum, all workers in the State Highway right of way, except when in their vehicles, shall wear the following personal <br />protective equipment: High visibility apparel as specified in the Traffic Control provisions of the documentation <br />accompanying the Notice to Proceed related to this permit (at a minimum, ANSI/ISEA 107-1999, class 2); head <br />protection that complies with the ANSI 269.1-1997 standard; and at all construction sites or whenever there is danger of <br />injury to feet, workers shall comply with OSHA's PPE requirements for foot protection per 29 CFR 1910.136, 1926.95, <br />and 1926.96. If required, such footwear shall meet the requirements of ANSI Z41-1999. <br />Where any of the above-referenced ANSI standards have been revised, the most recent version of the standard shall <br />apply. <br />3- The Permittee is responsible for complying with the Revised Guidelines that have been adopted by the Access Board <br />under the American Disabilities Act (ADA). These guidelines define traversable slope requirements and prescribe the <br />use of a defined pattern of truncated domes as detectable warnings at street crossings. The new Standards Plans and <br />can be found on the Design and Construction Project Support web page at: <br /><h ://www.dot.state.co.us/DesignSup~, then click on Design Bulletins. <br />If an access permit is issued to you, it will state the terms and conditions for its use. Any changes in the use of the <br />permitted access not consistent with the terms and conditions listed on the permit may be considered a violation of the <br />permit. <br />The applicant declares under penalty of perjury in the second degree, and any other applicable state or federal <br />laws, that all information provided on this form and submitted attachments are to the best of their knowledge <br />true and complete. <br />1 understand receipt of an access permk does not constitute permission to start access construction work. <br />Applicant's sign re PrIM <br />n <br />me papa <br /> a <br />- <br />wont ~DLLEn1B~"~ g ~J OS <br />If the applicant is t the owner of the property, we require this application also to be signed by the property owner or <br />their legally authorized representative (or other acceptable written evidence). This signature shall constitute agreement <br />with this application by all owners-of-interest unless stated in writing. If a permit is issued, the property owner, in most <br />cases, wi be lis the permi a. <br />Props rsi re Pdn na D <br />• ~ O <br /> <br />• s <br />Prwbw edWOns an obsoNb and may not M wed Page Z o/2 CDOT Form 1177 17/a{ <br />