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lOI/SEtIIIA COVNI'Y ROl1U DEPMMENT <br />1680 BMT. 165, CORTEL, C0~321 <br />~~ 19701 363-8666 <br />ApPLIUSION ' <br />In ortler tv facilitate Companies and indiviUua is needing Co dig in, or tli9turD, a <br />county eight-o[-way this applicac ion muse be comp Le ted prior tD sold activity. <br />gala?f 97 aPPx ~BveQ~i - <br />Da[ Add [f S9 oC Activity <br />Name) u[ mpany U lndiv;dml Companys~-- <br />.SfnS -1100 ~ _ <br />Name ignacure of RMyresentaciva Tolepnone Number ~~yy~//~~ <br />Tou moat crontact ~^ ~ti~,,. er at ~(r `'~O~lp <br />4a bourn balora Consan eork on this pcojact. 'Ihe Montezuma County Road <br />Foreman, by authoclcy or Resolutlnn 1111-95, adopted by iha Non[v xuma County Ooa rd <br />of Commlsslone rs, he rC Dy au[hori zes the aDuve named applicant to o t e fullowi ny <br />lincluding type and exact road loco clonsl /lr;,z~..~ <br />•• PL4118E AITACY A BI\4ZC SIRSGI OP GONBTRUCSION ACSMZS•• <br />Cy11pLLatCE rrlxR t,AN: Applicant shall at. a1L [imCS comply witA aLl rules xnd <br />regulations of the Slate of Colorado anU Monte r. NCUw COUnLy an connection wi to such <br />connr.ruction, installation, ylacinq ur us! auChon :Cd he [sunder. <br />APCL[CANT MUST CONTACT THE UTI LI_TY NOTIFICATION CENTER OF COWRADn AS <br />1-BUO-922-19H7 PRIOR TU DIGGING FVR UTII.]'CY NOTIf'1CATI ON AND LCx;ATI ON. <br />ONE CALL TICKET NUNeER IS; <br />FEES': The following Cavs are in effect for [nC cucrenl calendar yea c: <br />DRlvalwx: ResldC ntial oc Cummeccial: 5100.00 par location <br />• RZGH IlffACT: <br />ROAD eREACa: Asphalt ruatls: 31,009. 09 par lxatlon <br /> GcaveL colds: i 300. 00 par location <br />• aOh0 anu: Asphalt rondo: a 50. 00 par loeaelon <br /> Gravel roads: a 50. 00 par location <br />• All work performed from shoulder o[ road Lo bottom of d1 CC11: <br /> 9300.00 par nila or 0.10 par foot <br />LOR D>pACT: <br />BOICOm o[ Ui[ch Lo R.O.G. fence: 530.00 par location <br />All work pe rformCd tram bottom of ditch to R.O.M. fence: <br />!430.00 per atila or O.DS par foot <br />All aDDlican cs are vncou raged to dv construction as tar frots the roatl shouldor <br />as possible. <br />• All applicants ara responsible for [hv clean up of the county right-vC-way. <br />• Applicants shall immediately repair and restore all dis tu[bances or the road or <br />ri qh c-oC-way to current county speciflca tl ons. Upon failure to do so [he <br />county may repair or restoce and the aDpll cant shall be liable co, and own, Ina <br />rounty for all [eaaonable costs and expenses Incurred. <br />• No Company or person sna 11 tli0 Sn, Or tll9turD, county right-o[-way without <br />complylnq Mith [I~e above. IC the cv is a Nana fLde ems cgency. Bald conglany ur <br />person Shall deal with th0 ems rgency in an appropriate manner and comply wiCh <br />the above prucetlure on Ll~e nCx[ worki nq day. <br />FdEa <br />1) : <br />30.00 <br />/ <br />^ <br />TVfAL DUE AND PAYABLE <br />: <br />31 ~ <br />C <br />500.00 ~ <br />r~~ <br />~rM+L~'Ci S ~L C71t ~G <br />~noi <br /> <br />\ d' ~ <br />c <br />~ ) 1, 000.00 ,, ) <br />31 5.10 per Coot x C[. ~ V( /~ / <br />6) 5.03 per Yoot x ^ft. • 51 qna a Uistri of Fo clman Oate <br />~pceived <br />1: ? ~ ~~ <br />~ran~o Field OHic9 <br />~rnsicn of PAinarals & Geology <br />