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COLOgADO DEPARTMENT OF HI YS Icculnp eulhorily <br />APPLICATION FOR STA HIGHWAY ACCESS PE IT aa1Bllo9~p //eptenC' <br />^` <br />J <br /> i <br />/ <br /> <br />Instructions: <br />- contact the Department of Highways or your local government to determine your issuing authority. <br />- contact the issuing euthorlty to determins what plans and other dOCUments ar0 raquiretl to be Submitted with your <br />applicatipn. <br />• complete thl9 form (some questions may not apply to you) & attach sll necessary documents end submit it 10 the <br />Issuing authority. Submit an epplicati0n for each access requested. <br />~' <br />fype <br />- I1 you have any questions contact the issuing euthorlty Please prl <br />~~1 <br />tl Property owner (Permllt9e) 21 Appkcint " ' <br />r^~ <br />Pathfinder Development ~ <br />•j <br />itree iddriic. Illy, street address, city, txpr, p <br />.. Olfiia <br />TflANlPdflr <br />P . O p <br />Al/ <br />alele a lip Phone N e191a d e10 PhOni fia7apa/- <br />Colo. 81435 303-728-3403 <br />3) Address of properly to bs aervld by permit (it known) <br />3067 H1 hwa 145 <br />it Lapel descripllon Of property' <br />county lubdlvlllon Dlbck lot iiCtlon IOwnihlp range <br />g 5 1 <br />1 <br />g acceel from? <br />S) Whil etste hiphwiy ire you riqu 6) Whil Bide 01 Iha hlghwey7 <br />5 <br />i ~ O N O S CIE [~ W <br />7) Now many loaf lithe propoiid iCCeSO from the niareit mill poll or troll liraat7 <br />umb <br />teal (®S E W 1 from <br />s) Check here If you era requaitinp e <br />^ nOW BCCeaB Q temporary aCCe98 l3 Improvement to existing aCCe95 ^ CI18nge In aCCBia U9e <br />B) What lithe approxlmela date you Inland to bapln tonslru0ti0n? <br />t0) Do you hive knowledge of my State Nlghwey iccaii pirmlil serving thli properly, of for idJeeent propenlei In which you hpy6 i property In{aralt. <br />^ yes ~ no If "yes" - what ere the permit number(s)? _ end/or, permll date <br />11) Doal Iha property ownsr own or have any intsreeti In my idJioent properly9 <br />^ yea !9 no If "yes" -please describe: <br />12) Ars iheri ixliting or dedicated public atreeti, roads, hlghweyi Or eceess eaie o.onls bortlering or within the property9 <br />~ yea ^ no If "yes" -list them on your plans and Indicate the proposed and existing access points. <br />t71 II you are requeiling eommerclal or Induetrlal eccsii plesle Indlesta the lypai and nuntoer of bullneaesi and provide Iha IlOdr arse equsre <br />footage or each? <br />builneii lgUari 1001ege builnuie equeri lodleg0 <br />Commercial ravel 4000 <br /> <br />10) If you ere raquesdnp agricultural Ileld acceal <br />- now many acres will the access serve9 <br />tS1 If you are requeitlnp roatdentlal development ecceee. -whet le the typo (single limlly, apartment, townhouse) antl number of unlti7 <br />type ~ '• number of unlli type number of unlll <br /> <br /> <br />18) Provide the lollowing vehicle count eetimetie for vehicles that will uaelhe access. Leaving properly then returning la two counla. Intllcetd ll <br />your counts are peek hour volumai yZer average dally volumai l7. <br />i 01 Peaiongere core end Ilphf trueka N of multi unit trucks N of other vshlcle3 <br />.1 1.4 <br />N of elnpla troll vehlclea In excels o1301t N of term vehl0lei (held equipment) Total Count el All Vehlalee <br /> 1.5/hr <br />17) Cheek with the IOlping authorlly to tletirmine which Ol lne lollowlnp doeumenta ere required l0 OOmplels the review of your appll0allon. <br />(plan) Should be n0 lafger Than $d" x 3B") o) Properly map Indlcetlnp other eCeeta. bordering roads antl atreeti. <br />•1 I-ugnwny end tlrlvewiy plan antl prorlla II Prdl:osed ecCOla dealgn <br />D) Oralnepe plan showing Impact to the hignwey right-ol-way. gl Parcel and ownerahlp magi Including eiaementl. <br />cl Map and reuen delelling utility looiuena before and dlor h) Slgning end elri plop plena. <br />duvclopmenl In and along the rlgnl-of-way I) Trallic oontrol plan <br />dl Subdiviilon, zoning, or tlavelopmenl plan )) Procl of Ileblllly IneuranCe <br />It en access parmlt Is Issued to you it will State the terms and conditions for Its use. Any changa9 In the use OI the <br />permitted aooess opt oonslstont with the terms end conditions listed on the parmlt maybe considered a vl0lation o} <br />the permll. <br />THE APPLICANT DECLARES UNDER PENALTY OF PERJURY IN THE SECOND DEGREE, AND ANY OTHER <br />APPLICABLE STATE OR FEDERAL LAWS, THAT ALL INFORMATION PROVIDED ON THIS FORM AND <br />SUBMITTED ATTACHMENTS ARE TO THE BEST OF THEIR I:NOWLEDGE TRUE AND COMPLETE. <br />ApPllcenl algnat ; ~ <br />t. <br />yl Date <br />` <br />If the epplicentls not the owner of the grope y, we require this ap cation x190 l0 be signed by the pro arty wneror <br />their legally authorized repre90ntetlve (or other acceptable written evidence). This signature shell constitute <br />agreement with this appllcetion by all owners-ot-Interest unlsss slated In writing. If a permit is authorizotl, the <br />properly owner will be listed as the permittea. <br />Properly Owner slgnelura Date <br /> [, <br />r•r~weYr eP111P11~mPy Y1 VI~V 41, 111 rYPY~~~~~•~Y~PPY~I~Y { ( •• -•~•' <br />vat'. <br />