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= ISTA.TE H1G WAY ACCESS PERMIT APPLICATION ~; °j~~'"O ( 7M <br /> <br />Inslruclionsl contact the Department of Transporlalion or your local government to determine your issuing aulhorily. <br />O a, contact the Issuing authority to determine what plans and other documents are required to be submitted <br />' <br />O with your <br />application. ~~ <br />Q complete this loan (some questions may not apply to you) and attach all necessary documents and <br /> submit it to the Issuing aulhorily Submit. an application for each access requested. <br /> H you have any questions contact the issuing aulhorily Please prlnl or Type <br />Il Propery owner (Parini ea) ~ 21 Appkcanl .---_ <br />Randall Che ion Kerr & Son Trucking <br />SU@@18ddrasS, Gy Slra@l addr@sS, Cly <br />26000-U.S. i hwa N285 Buena Vista P.0. Box 1496 Buena Vista <br />wmarip plwner ameaap phone r~ <br />81211 719-395- CO 81211 719-395-3163 <br />3)Address al prepay rob served by permit (ilWrown) <br />6 OO~~U~;S.<~ i hwa 285 - <br />IjLegddescdplianalpra ry: <br />m,saY'': ~ 5-::., :'!~ sdd' <br />Chaffee kn Dbck b ~ s.eion iwnsFp <br />~•SEE AT ACHED^^ - 33 6 34 14 South ~Na/8 West <br />sl Whalsmlehghway are mresryesungattess lrom? G)Whal side of the highway O N ^ $ ~] E ^ W <br />U.S. Ni hwa N285 -' <br />7J HOw many teal is Ne pr sad accaas lrom NO nearest mile post? How many teal is Na proposed access lrom the n4aresl cross alreel? <br />' teal(' a: N S E W )Irom~ 147 _1,800 loet (circle: N S E W )Tram: Count Road 320 <br />e)Chackhere it you aror uesdrga <br />O new access ^ t mporary access O improvement to existing access ~ change in access use O removal of access <br />97 Whalis Ne apprexGnau leyou inland to begin conslrucuoN <br />N/A <br />101 f)o you )law knowledg of any Stale Hphwayacwss permits serving Nis propery, ar adjacenlproparves in which you hawapropary interest. <br />~ no ^ ye , if yes • what are the permit number(s)?: and/or, permit date: <br />I1j Do@s the properyowne own orhavb ary GUerezts in any adjacent propery) <br />RECEIVED <br />® no . ^ ye , it yes - please descdhe: <br />12J Ara there oNaresisGng rdedicatedpubfic aveels,roads, highways or access eaz@rrlenls bordering orwiNin lh@propery? <br />W no ^ ye , it yes • list Them on your plans and Indicate the proposed and existing ~~~~~. y ~~~ <br />13)Ilyau are requesfingm merdal orinduzuial access please bldirale Na types and number of businessesaM provide the lloor area square lmlage of each. <br />WSN@S square )Dotage bU51n05a square loolaga <br /> <br />Sand & Grave w/E ui ..Re air 3,000 <br /> <br />I4) II you are requasung egr Iwal field access ~ how many eras will vie access senro7 <br />N/A <br />ISJ 1l you ere requeslvg rear nllal dawlopemenla«ass. whalis the ype(singl@Wmiy, eparlmonl, rownhouse)andnumbaz of units? <br />~ <br />ypa wmbor of units type number of units <br />Sin le Famil ~ 3 <br /> <br />6jProvitle NatoAowing v@h bmunt estimates lw whidas that wiA use Na access. Leaving the properly than rewrning is two mums. Indicate it your counts are <br />O peak hour v tomes or ®average daily volumes. <br />dpwwgr,on WipN bola rd,Mtiw uwAS •ddlxr r4KN, <br />12 10 <br />tlMyY NJ rtliY,n~,rn,tl k Itllvmr~~ub, IliWl pupnnx) ~ Tol@ICOYaI OI aII V@MCbs <br />10 32 <br />nChackwiN N@issuing avl ady bdelermine whidt of the lolbwmg dommonls aze requiredbmmdela the review olyour application. <br />(pWns ahoNd be n larger Nan 24'x367 ' <br />o) PropeM map in6meng other acwss, bordering roads and streets. <br />aj Highway end dd ewayplon prolile. I) Proposed access design <br />b) Drainage plans wring impad WNe highway righo-abway. g) Parml antl ownership mapsinduding easements. <br />c) M.ip and lellazs lading utility lomvons halos and abnr h) Skjning and striping plans. <br />rfawlopmenlin Mabrg Nerighl~o6way, i) Trallk conuol plan. <br />d) Subdvisjon, ion ,arrdewbpmamplan. j) Prool of Gabiliy insurance. <br />11 an access permit is ssued to you II will state the terms and conditions for its use. Any changes in the use or the permitted <br />access not consislenl with the terms and conditions listed on the permit may be considered a violation of the permit. <br />The applicant decla es under penalty of per)ury in the second degree, and any other applicable state or federal <br />laws, that all Inlorm Ilon provided on lhls loan and submttled atlachmenls are to the best of their knowledge Irue <br />and complete. <br />II the applicant is not ~he owner of the property, we require This application also to be signed by the properly owner or (heir <br />legally authorized representative (or other acceptable written evidence), This signature shall consltlule agreement wdh This <br />applicalbn by all own~grs-ol-tnlerest unless slated in writing. If a parer) is authorized. the propery owner will be listed as <br />the perminee. {, <br />ore <br />