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4'14'OS Ke`r/~iU2Gt l~~-LC cxXK~sx <br />3 9~ <br />COLORADO DEPARTMENT OF TRANSPORTATION , Issuingauthoriryappl anon <br />~ <br />y <br />S i HTE HIGHWAY ACCESS PER APF~ICAfi N acceptance date: ..- <br /> <br />Instructions: -Contact the Colorado Department of Tr ortatien O yourloca vernment to determine yourissuing authority. ' <br />-Contact the issuing authority to determi what plan docume re required to be submitted with your application. <br />- Complete this form (some questions m mot apply toC~~~i attach al cessary documents and Submit it to the issuing authority. <br />AfPIG ~ <br />P/t?85B <br />rint <br />p <br />- Submit an application for each access a ed. Tp <br />O! type - If you have any questions contact the iss Itt~author~~~' r~ <br />-FOradditional information see CDOTs Acce nagementwebsit t A P i <br />t) Property owner (Pennittee) permittee (if different from property owner) <br />Phil Wolf SC Transportation Consultants, Inc. <br />Street address Mailing address <br />P.O. Box 16804 ~~ 1889 York Street <br />City, state & zip Phone # City, state 8 zip Phone # (required) <br />Golden, CO 80401 303-931-9096 Denver, CO 80206 303-333-1105 <br />E-mail address E-mail address if available <br /> aja@lscdenver.com <br />3) Address of property to be served by permit (required) <br />N/A <br />d) Legal description or property: If within judsdic9cnai limits of Municipality, city and/or County, which one? <br />CWnIY 911iIdIVt31IX1 bOCk iOt 9eLLOn [OWn3Ctlp rdn[fe <br />Gilpin N/A SE1/4Sec 26 T35 R72W <br />Sj What State Highway are you requesting access from? 6) Wha[ side of the hi hway? <br />SH 119 ~N ~S ~ E ~ W <br />7) Flow many feet is the proposed access from the nearest mile post? How many feet is the proposed access from the nearest cross street? <br />0 feet^N S^E W)trom: MP 1.3 feetQN^S^EQW)fram: <br />8) What is the approximate date you intend to begin construction? <br />6/1/2005 <br />3) Check here if you are requesting a: <br />Q new access temporary access (duration anticipated: ) improvement to existing access <br />change in access use removal of access ~eloca[ion of an existing access (provide tletail) <br />t 0) Provide existing property use <br />Surface Inning/One Residence <br />t) Do you have knowledge of any State Highway access permits serving this property, or adjacent properties in which you nave a property interest? <br />^no Qyes, if yes-what are the permit number(s)and provide copies: No. 103039 s 100052 and/or, permit date: <br />2) Does the property owner own or have any interests in any adjacent property? <br />^no ~ yes. if yes -please describe: <br />3) Are there other existing or dedicated public streets, roads, highways or access easements bordering or within the property? <br />I] no J yes, if yes -list them on your plans and indicate the proposed and existng 2ccess points. <br />4) If you are requesting agricultural field access -how many acres will the access serve? <br />5) 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 />business land use square footage business square footage <br />Surface Mining 500 acres <br /> <br />~t If you are requesting residential tlevelopement access, what is the type (single family, apartment, townhouse) and number of units? <br />type number of units type number of units <br />. residence <br /> <br />:') Provide the foilewing vehicle count estimates ror vehicles that will case the access. t.aavine the propam then returning is hNn rcunts. <br />,dicate if your cnunta are x ni passenger cars antl figm trucks a~ peak nWr ~dumes p of multi unit (rucks at peak nour volumes <br />(peak hour volumes or Qaverage daily volumes. 15 10 <br />a single umt venldes in excess o~ EO tt. r pr farm venues Uield eWlpmeni) Total count of all vehi <br /> 25 - EXHIBIT <br /> s <br />Previous editions are obsolete and may no[ be used Page 1 .9 <br />