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COLORADO DEPARTMENT OF TRAN3PORTATION Issuirg aulhodty applicetlan <br />STATE HIGHWAY ACCESS PERMIT APPLICATION acceptance dale: <br />InsWCdons: -CoMad the Colwatlo Department ofTrensllortatlon(CDO7)wyour local government to determine youriseuing authority, <br />- CoMaq the Issuing authority to determine what plans antl atrer documents are required to be submitted with your epplicatlon. <br />- Complete Ods form (some questlons may not eppy to you) and attach aO necessary documents and Submk It to the issuing authority. <br />PleasB print -Submit en applMatlon for each access a6ected. <br />O/ typB O you have ant questions coMad the Issuing autladty. <br />-For eddlOonallMonnatlon see CDOTs Access ManagemeMwebsite at ~^•//www.doL~~v ea ~~/Ae^,aasParmHSnnda hhn <br />1)Propedyowrler(PemdOee) )AgeMfwpenntkee(Ifditierentfrompropertyowner) <br />Clarence Champion <br />Street atltlress Mailing address <br />26000 U.S. Highway (1285 Buena Vista <br />City, state 8 zJp Phone# City, state 8 zip Pfane#(required) <br />CO 81211 719.395.1210 <br />E-mall address E-mail address k available <br />champ003Bmen.com <br />3) Address a property to be served by permk (required) <br />26000 U.B. Highway 2S5 <br />4) Legal description of property: If within Judstlidional limits of Munidpality, dly ant/w County, which one? <br />Ch ffee +M EE ATTACHED ~ br 3~S 34 1South 78 Weat <br />5) Whal State Higtwvay are you requestlng access fromT 6) What side a the h hway7 <br />II.S. N285 ~N ~S ~ E ~ W <br />7) How marry feet is the Proposed access from the nearest mile post? How many feet is the proposed access from the nearest cross street? <br />530 feet^N S^E from: 147 1600 teat N^S^E^ from: 320 <br />8) What is tl18 appro>amate date you Intend to begin construction? <br />9 Check here kyou are requestlng e: <br />~] new access ~temporery access (duretlon andapated: ) Qimprovement to existlng access <br />Q change in access use removal of access ~'elocetlon of an existlng access (provide delaiq <br />10) Provide existlrg Properly use <br />Reaidenae/gravel pit _ <br />11) Do you have knowledge of arty State Hgttway access permks serving tNS property, or adjacent properties in which you have a property IMerestt <br />©no yes, If yes -what are the pennk number(s) and provde copies: andlor, pennk date: <br />WOT 501066 11/07/01 <br />12) Does the pro owner own or have arty Interests In arty adjacent properly? <br />~rw ~ yes, k yes -please describe: <br />73) Are there otlrer edallng or dedicated public streets, roads, highways or access easements badertng orwitMn Ore propertyT <br />0 no ©yes, tl yes - tlst them on your Plana and indicate Ore proposed arM existlng access points. <br />14) If you are requesting agrtcukurel fieltl access -law many awes will the access serve? <br />N/A <br />15) If you are requestlng commerdel w indusbial access Dlease indicate the types and number a businesses end provkle the flow area square footage of each. <br />busineasllantl use square footage business square footage <br />Sand 6 Gravel 10 aarea <br /> <br />i6) If you are requestrg resldentlal tleveloperrrerit atxess, wfmt is the type (single famky, apadmen4 townhouse) and number of unks? <br />type number of unks type number a units <br />Sinqle Family 3 <br /> <br />17) Provide tlfe following vehiae count estimates for veNdes that will use the access. Leaving the property then returning is two counts. <br />Indicate kyWr counts ere M or passrpar care ark Ilyp nuGe r parr nor whines a cf nsls um bucks r Ibex hpr vMrrbs <br />ak hour volumes wQaverege daly voumes. 25 185 <br />e drrga um wnlresM excaaaau n, eatrm wnxtea (Wept egrprem) TOfaI GOUM Of all vehlelas <br />50 260 <br />Vnvbua Mklona an obsolaM and msy not W uaetl Vega 1 of 2 CDOT Fonn M77 17JOt <br />