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18) Check with the issuing authority to determine which of the following documents are required to complete the review of your application. <br />a) Property map indicating other access, bordering roads and streets. e) Subdivision, zoning, or development plan. <br />b) Highway and driveway plan profile, f) Proposed access design. <br />c) Drainage plan showing impact to the highway right-of-way. g) Parcel and ownership maps including easements. <br />d) Map and letters detailing utility locations before and after h) Traffic studies. _ <br />development in and along the rightof-way. ) Proof of ownership. <br />1- It is the applicant's responsibility to contact appropriate agencies and obtain all environmental clearances that apply <br />to their activities. Such clearances may include Corps of Engineers 404 Permits or Colorado Discharge Permit System <br />permits, or ecological, archeological, historical or cultural resource clearances. The CDOT Environmental Clearances <br />Information Summary presents contact information for agencies administering certain clearances, information about <br />prohibited discharges, and may be obtained from Regional CDOT Utility/Special Use Permit offices or accessed via the <br />CDOT Planning/Construction-Environmental-Guidance webpage htto:llwww.dot.state.co.us/environmental(Forns.asQ. <br />2- All workers within the State Highway right of way shall comply with their employer's safety and health policies) <br />procedures, and all applicable U.S. Occupational Safety and Health Administration (OSHA} regulations -including, but not <br />limited to the applicable sections of 29 CFR Part 1910 -Occupational Safety and Health Standards and 29 CFR Part 1926 <br />- Safety and Health Regulations for Construction. <br />Personal protective equipment (e.g. head protection, footwear, high visibility apparel, safety glasses, hearing protection, <br />respirators, gloves, etc.) shall be worn as appropriate for the work being pertormed, and as specified in regulation. At a <br />minimum, all workers in the State Highway right of way, except when in their vehicles, shall wear the following personal <br />protective equipment: High visibility apparel as specified in the Traffic Control provisions of the documentation <br />accompanying the Notice to Proceed related to this permit (at a minimum, ANSI/ISFJ~ 107-1999, class 2); head <br />protection that complies with the ANSI 289.1-1997 standard; and at all construction sites or whenever there is danger of <br />injury to feet, workers shall comply with OSHA's PPE requirements for foot protection per 29 CFR 1910.136, 1926.95, <br />and 1926.96. If required, such footwear shall meet the requirements of ANSI Z41-1999. <br />Where any of the above-referenced ANSI standards have been revised, the most recent version of the standard shall <br />apply. <br />3- The Permittee is responsible for complying with the Revised Guidelines that have been adopted by the Access Board <br />under the American Disabilities Act (ADA}. These guidelines define traversable slope requirements and prescribe fhe <br />use of a defined pattern of truncated domes as detectable warnings at street crossings. The new Standards Plans and <br />can be found on the Design and Construction Project Support web page at: <br /><http://www.dot.state.co.us/DesianSupportl>, then click on Design Bulletins. <br />If an access permit is issued to you, it will state the terms and conditions for its use. Any changes in the use of the <br />permitted access not consistent with the terms and conditions listed on the permit may be considered a violation of the <br />permit. <br />The applicant declares under penalty of perjury in the second degree, and any other applicable state or federal <br />laws, that all information provided on this form and submitted attachments are to the best of their knowledge. <br />true and complete. <br />1 understand receipt of an access permit does not constitute permission to start access construction work. <br />~Applicanrs signature Print name Date <br />Q ~~ ,~~~ J- Aa.,,~ I ~ r.,ua 3 ~zz to f <br />,lam , <br />If the appli nt is not the owner of ~~~~~~tthe property, we require this application also to be signed by the property owner or <br />their leg thor' representve (or other acceptable written evidence). This signature shall constitute agreement <br />( with thi a i n by II owner -of-interest unless stated in writing. If a permit is issued, the property owner, m most <br />cases ~ be d as t oerml ee. <br />Date <br />J <br />Previous ed'~tions are obsolete and may not 6e used Page 2 of 2 CDOT Form #137 <br />