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®~9p®c ul~Ir/~1y,®VO M®MlY t 1 R®I1® AI~® I~RI®~iE ®~PT. PERMn NUMBER: ~~d r7~7q~/j R{GHT-OF°WAY ACCESS PERMIT ROAD NUMBER: C Q f (~ y~ o~sTwcr No: THEPERMITTEE: ~US"" i- 1 AO.7l. ~"~r f71~~ t'~t~Cr~~'S ~/~//~/~~/f~ ^/ - 1__~___~. ~' kv (~J/ //~'/~~ ` J / f/~~//~/~ I'` ~ ~ / SUPERV190R: LVr G/S'L -~/~L i• i~~l( ~l~/7` /r/2i°~~r° ~'-/. j7 I~~T/ DAiE ISSUED: I Z~I~~OS is hereby requesting permission to construct and use an access to a county fight-of-way at the location noted below. The access shall be consVUCted, maintained and used in accordance with the terms and conditions of this permit including listed attachments. Sketch shall include frontage of lot along mad, distance from centerline of road to properly line. number of driveways requested, width of proposed driveway(s) and angles, distance from building(s) andlor other facilities. The applicant binds and obligates himself to construct and maintain the right-of-way access(es) in accordance with the provisions. specdicatlons, and conditions enumerated in this document This permit may be revoked by the issuing authority if at any time the permitted access and its use violate any of the terms and conditions of [his permit. yy,p pp LOCATION: (Please InNCate county road and nearest mile postin addition to address.) 1 era ~ t)~ ~ ~-`f ACCESS TO PROVIbE SERVICE/pn TO: /~ .{- SKETCH: This pertrel Shell he made eeeilahle al Bte rile wrere and when work k Ceing Jere. A work sketch or dmwirlg df the proposed driveway(s) must accompany appf Wtion. /- N + l 4 . ~ ~&'~"`:/ +Pixrrd~ ~~' itfSCpa ~7p"', "%A;t/u.7~r S r b~~ f t^ d Cu~Ui-n~ !N 1~~X~ cryurG:.-r yri ~' / '~~(-N j~ ~Sr'~C hM LirrAt ~F.:.. N` r ~J ~~... ../ / ~. "~ ~O.rN ic, r., d. GENERAL PROVISIONS: (See reverse for SDedflcallons) 1. The Applicant represents alt parties in interest, and affirms that the driveway approach(es) is to be constructed by him for the bona fide purpose of securing access to his property and not for the purpose of doing business or servicing vehicles on the rightof-way. 2. The Applicant shall furnish all labor and materials, perform all work, and pay all costs in connection with the construction of the driveway(s) and its appurtenances on the right-of-way. All work shall be completed in an expeditious and sate manner and shall be finished within 30 days of the Permit date. 3. The ype of construction shall be as designated andlor approved by the Road Department and all materials used shall be of satisfactory quality and subject to inspection and approval of the Department. 4. The travelffng public shall be protected duritg We installation with proper worming signs and signals and the Department and its duty appointed agents and employees shall be held harmless against any action for personal injury or property damage sustained by reason o1 the exercise of [he Permit. 5. No revisrons or additions shall be made to the driveway(s) or its appurtenances on the right-of-way without the written permission of the Department. 6. Provisions and specificatioru outlined herein shall apply on all roads under the jurisdiction of the Department. 7. Staking or flagging access boundaries is required prior to approval. 8. This permit does no[ allow any damage to occur on the existing county right-ot-way. If permittee causes damage to the .county road, permittee shall repair road to the county's satisfaction. 9. All driveways permitted must have 6" of/." road base on the surface from the point it intersects the eounry road to the edge of the county road right-of-way. OTNER TERMS AN. OCOr+9{T18N5: All U[ihry lnslallationS, INCLUDING FEE ,L~pi•` 1/V~ TELEPHONE LINES, require an Underground Utility Permit issued from this department. Upon signing This permit the permittee agrees Ip the leant antl contlilion5 and referenced anachments contained herein. The permitted aCtest Shall t>e complBletl m accorCance with Ine terms or the permit MMto Being used. The permittee shall notlty with the Rio Blanco County Road and Badge Dept. hpurs prlvr Io commencing constmeavn withn tna Rio 9lanco County right<f-way. The person signing as the permittee must be the owrer or lapel representative of the pmpeny served try the permitted access and nave full authprity to accept Ire permu and a0 iL5 terms and cm0ilions//n J ,~ ~ /7 l.y PermrRee /sty.'>C'/J't ~hr':•~? ~:a /~ ~S ?C•a :, ~/ Dala ~ r APPROVAL: _-~-~ .` This permit is clot valid until aipned by a dory authorized representative of We Department. RIO HLANCO COt1NTV ROAD AND BRIDGE DEPARTMENT MeekerOisrrlcf: 570- Ind Sf., P.O. B K MeakeA Colorado 816[! (WBJ B7B-6601 Rangely Ofslrice 17!97 Nwy. 64 RangafY`^Co/orado 876/8 (970J 675.8610 9y~~~ .,i/ Oab ~ 0 ~ Title ~f ~ J COPY DISTR I While -Applicant Yerlow - R atl 8 Bridge Admin. OHIce Pmx -Development De nmt:nt