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Qeceiuec~ <br />COLORADO DEPARTMENT OF TRANSPORTATION ,L3 9~~ Issuingauthoriryappl tion ,,. <br />3 r iaTE HIGHWAY ACCESS PER API~.ICAfi N acceptanoedate: ~~,: <br />Instructions: -Contact the Colorado Department of Tr ortation your loco vemment to determine your issuing authority. ~~'-'- <br />- Contact the issuing authority to determi hat plan docume re requiretl to be submitted with your application. <br />- Complete this farm (some questions m of apply to~,¢~ attach al <br />essary documents and Submit it to the issuing authority. <br />b <br />PleaSt? print - Submit an application for each access a ed. ~ <br />p~ tYPe - If you have any questions rgnfaCt the iss a~author ~ <br />- Foradditional information see CDOTs Acce nagement websit <br />1) Property owner (Permittee) pernittee (if different from property owner) <br />Phil Wol£ SC Transportation Consultants, Inc. <br />Street address Mailing address <br />P.O. Box 16804 ~~ 1889 York Street <br />City, state & zip Phone # Ciry, state & zip Phone # (required) <br />Golden, CO 80401 303-931-9096 Denver, CO 80206 303-333-1105 <br />E-mail address E-mail address it available <br /> aja@lscdenver.cotn <br />`3) Address of property to be served by permit (required) <br />11 N/A <br />~4) Legal description o} property: If within jurisdictional limits of Municipality, city and/or County, which one? <br />ceunry subo9vislon black lot section tawrenip range <br />Gilpin N/A SEl/4Sec 26 T3S R72W <br />S) What State Highway are you requesting access from? 6) What side of me hl hway? <br />SH 119 ^N ~S ©E ^W <br />7) How many feet is the proposed axess from the nearest mile post? How many feet is the proposed access from the nearest cross street? <br />0 feetaN S^E W)from: MP 1.3 feet FrN^S^E^ from: <br />8) What is the approximate date you intend to begin construction? <br />6/1/2005 <br />9 CFteck here if you are requesting a: <br />~~ new access ^temporary access (duretion anticipated: ) ^improvement to existing access <br />^ change in access use ^removal of access Qrelocation of an existing access (provide detail) <br />10) Provide existing property use <br />Surface Mining/One Residence <br />1 f) Do you have knowledge of any State Highway access permits serving this property, or adjacent properties in which you have a property interest? <br />~no Qyes,ifyes-what are the permitnumber(s)andprovidecopies: No. 103039 & 100052 and/or,pernfldate: <br />12) Dces the props owner own or have any interests in any adjacent property? <br />~no yes, if yes -please describe: <br />7 3) Are there other existing or dedicated public streets, roads, highways or access easements boMering or within the property? <br />Q no ^ yes, if yes - list them on your plans and indicate the proposed and existing access points. <br />i 4) If you are requesting agricultural field access -how many acres will the access serve? <br />15) If you are requesting commercial or industrial access please indicate the types and number of businesses and provide the floor area square footage of each. <br />businessAand use square footage business square footage <br />Surface Mining 500 acres <br /> <br />t6) If you are requesting residential developement access, what is the type (single family, apartment, townhouse) and number of units? <br />type number of units type number of units <br />4 l residence <br /> <br />~ : ~ Provide the tollowing vehicle count estimates for vehicles that will use the access. Leaving the property then returning is two counts. <br />. <br />_ <br />;ndicate if your counts are <br />k of passenger wrs antl IigM trucks at peak hour vtlumes <br />M of mWti unit trucks at peak hour vdumes <br />eak hour volumes or ^average daily volumes. 15 10 <br />1 d single unit vahldes in excess d 3o n. k d fam+ vehides lraid eeulpmeM) Total count of all vehi EXHIBIT <br /> 25 <br /> <br />Previous editions are obsolete and may not be used Page 1 <br />