|
.. _ ~1~'o~G:s
<br />• COLOFADO CEPAFiTMENT CF Tq ANSPOFTAiION I lawme PUnwhq aPp'Knl:on
<br />STATE HIGHWAY AC%cSS RERI'd IT ~;PPLiCATIO(J a=9vlenpae6le:
<br />1
<br />Ins(ruc;ions: - comae: the Department ai Transportafian ar ycur'BCaI government to tlelPrmiCO your isswno authority.
<br />- contact Ibla issu!ng authority Ic determine what pans and Dll:er documents ar? rzquircd to be submitted ,
<br />wlh your applicallon.
<br />- complete ;his !arm (some questions may not apply Ic ycu) and attach au necessary Uocumenls and
<br />JI suemr! It to !71e ~ssuin, authority. Submit ar, apphcatlon !or each access requested.
<br />it ycu have any Gueslions canlzet the Issuing autnonty. Please print o. type
<br />~ lib0 Grand Ave. ! PO 90:t 328 / 74ontDod ~ 47i0 Kannah:.Craek ~ Nhiteveter
<br />s:am b t'P ipncne Y ~Laln d ap Drano 1
<br />Colorado 81423 ~ (41Q ~1 327-4261 ~ Colorado 9152? I(970) 243-929d _
<br />]14aurCSS PI plCpelY ID be 6erveJ by penny (i kncwnl
<br />Not knave; Located at (k7hir Laop Nvy 2k5 Xi}e PoSL 63 8 _
<br />al'-e~ai upecnpuon of Dmcvly.
<br />San Miauel i SENk. SW k - ~ ear ! a ~ r~13,, ~ :>..,u,4~ N ri4Y ~NMPN
<br />5)WF.alyml0 hlpnwey are you requ¢slinn ace ass LOni ~3 Whel maa o: lh<Si nwa
<br />i o v n p~ rr S U E 9 'N
<br />ColoradD Hay 145
<br />)) I+pw many lapl H'bp pNppsetl amass l,nm 1"n9e9reJ1 The cpSl7~ 1hM manl-lea!!a Iha prpppFCC accass'rom .he npa'a4':J0.9] sUCNe
<br />t ,vnv lour ptrde, u(5)E w liraT:~rg_ ~ 840 Net (ciDl6~ k~5)G W Itrom~ PQ_625 _ __
<br />31 heck here it you era :ec~-es:inq x
<br />p YJhat is'I'.e BCprpr!mala L]IB W u!c'.entl In per;in cpnatNCtiM'
<br />rPi op yCU Iwva knowledge a(any stele F+lgllway dC.'au permtls saryin9 0.6 D:vperly, or adleCN(prbpenias fr. WhKrt yoc nave a property In;erert.
<br />Or no Oyes, it yes' -what are Ise pe:mil numberls}?: andlo5 permit tlale~.
<br />1:1 Does r119 Drppery ownm v+vn or haws any Insereab In any anixenr prPpmN7
<br />U no ~ yes, it yes -please describe: Uncompahgre National Forest
<br />'1 Ara llmre other enl51in0 or aauic4lbQ public slrnea rcwda, bighwnys o: arseas ea]emenls bordnnnq or wan,n the aoper Ir'
<br />G no :71 yes, ii yes -list tY,em en yaur plans antl indicate the proposed-and existing access Farnts.
<br />rDi ll YaJ are ragsresbng cammercie:`ar indua;,.al acc6cs Phase irWca(e p,e Hpea enQ rvmber of'vusinacs0x ane pwmtle the floor area Shan footage of axtr.
<br />tq ll you en repues!mq egr'.<mtaralana ec]oss-Iww many ee9s wm lha ecvasa serve? ~~ 17Gwr~
<br />Not Rppl tcab7e
<br />f5l tfyvu 0rt rnaVesGnq rnt+a9nualvwe+epem0ni eccass,vhn(u me lyye (single family, aparvnOnr,Mynhous i 1 '
<br />Rpe OVmbBr pl Unii< 1~s Yypo ~ rumher of urnl
<br />1 QI Pr VVIrIC ha IGIOwny VBn:CIY COLnI CS:Imalal IOI v9niya] 1^lll MI VSI the T:Ce94.:9e.Ma Ina p:OnOM1y Then rCUlnm~l iS Iw0 COUIIS.''nllKala I y Wr roJn14 are
<br />O peak haur volumes a~ ~ aveta9e GaIN vohfmas.
<br />.,.~,.... ,,.. w^, :,::.... sam.,n m+aaa isarn..¢akr.
<br />16 per day _ I rt 60 per day
<br />o".q. ene M[1lYm .see. o:ID` Lar L,m.LVn llYw qup..e•p r sa mute o(alt vehcten
<br />I I vl Cn9<k vGIP Ipa L1SUIn9 aVIOUfIIy IV rJOler Tin6 WI'ICb DI :ne iOiIV'mn9 d0<Gmani3 drtl 18Gu4Bd rb GOmbIC9111e {aw<w of your PppIIC81bn,
<br />lPlans eMuld'ba no Izrgar Ibz n 2a' ~ 36'?
<br />e) Pmparry map mdlWliny olhernxma, bo•pennp rD.-.Cs mrJ SVeee
<br />a! highway antl arv6way Ptrn prpme. 11 Prapasea suaas assign
<br />bl Draln6ge plan 6howsnp lmC6Gl10Ine Olghw-ay rly4i~pbwey. p) Parcel and ownership maCS locluCmg ea]Bmems
<br />c, ~lapaM tellers dalaillrsg utility kKaibns OBlcr9 arw al!er bl Si9Nnq and shlping plans
<br />tlWelJprrnnl In Ona Blmglne ripn:~obwap i) ?meicconlrol part.
<br />al 3vvil`ISlvw. coMrg, pr Ja.doPma•e plan. !) 2rmlel llab0iy lnsur0irco.
<br />II an apcass perm,! is Issuetl !o yo': i; will scale the !arms and condlllons for iIS use. Any changes in the use cf the parmeled
<br />access not canslslant with the terms and wr:dificrs listed on ;i:e permit may oa considerzd a vrol2lion of the Dermi;.
<br />1 The applicant declares under penalty P( perjury in the second degree, and any ocher applicable stale or federal
<br />laws, that ell intermation provided on 4hla.icrm and submitted aitachmeRts ate to the best of tFreir knowisdge True
<br />and complete,
<br />V/0 t .
<br />If Ifie aPPVca n; is ncl the owneaAne pro~er!y, we require leis agpiicdtion aISC IC bn signeU by Ibe preperiy owner o: Their
<br />ieyaf:y au:hOf126G repr¢e Hn:auvb (Or Viher ecceplable w~itlten eviden<s J. ThH ei(rnalUre snail consl'IU!e agreemanl with Ins
<br />application by a'A awne rs~Dhlnleresl unless staled in writing. II a permit's aulhori;ed, the p+operly axner wit! oe lissed as
<br />the perrp~e.-~1~c-~ _ /1
<br />
<br />..~ ::.:....:...:....... nr ...,,._:,:..,.,.,,.... ,.. ,~,,..._..,
<br />
|