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~ST/iTE HIGHWAY ACCESS PERMIT APPLICATION accepance ae: Instructions: -Contactthe Colorado DepartmentofTransportation(CDOT)oryourlocal government to determine yourissuing authority. -Contactthe issuing authoriry[o determine what plans and otherdocumentsare required to be submitted with yowapplication. - Complete this form (some questions may not apply to you) and attach all necessary documents and Submit it to the issuing authority. P/Ed51? PITI1l -Submit an application (or each access affected. Or type - If you have any questons contact the issuing authority. - For addifional information see CDOT's Access Management websile at httn~llwww dotstate co uslAccessPermits/index htm 1) Pro perty owner (Permittee) 2) Agent for pertnittee (if dilferenl from property owner) Fremont Cty. Roads Bridqe, RD s Brdge Admin Larsen Colorado LLC, Bill Williams Street address Mailing address 1170 Phelps Ave. PO Box 670 City, state & zip Phone # City, state 8 zip Phone # (required) ,Canon City, CO 81212 719-276-7320 Penrose, CO 81240 719-240-1533 E-mat I address E-mail address if available hcpbw@hotmuail. corn 3) Address of property to be served by permit (required) Approx.2 miles N. o£ Inter. of US HWY 50 6 Fremont Cty RD #69, then W. approx. 3/4 Mile. 4) Legal description of property: If within jurisdictional limits of Municipality, city and/or County, which one? county suhdlwsion blo[k b1 sedan lowmhb range NA NA NA NA NA NA NA 5) What State Highway are you requesting access from? 6) What side of the hi hway? US HWY 50 6 Intersection of CTY RD #69 ~N ~S ~ E ~ W 7) How many feet is the proposed access from the nearest mile post? How many feel is the proposed acceu from the nearest cross street? 3696 feet®N^S^EBW)from: MP 175 feetQN^S^E^W)from: NOne Within 3 Miles 8) What is [he approximate date you intend to begin construction? 6/1/2006 9) Check here if you are requesting a: ~«--,.~ new access temporary access (duration anticipated: ) improvement to existing acces"s~ !°~~-'='C%:j>, . khan a in access use removal of access ^relocation of an exislin aoce3s _ `(pray({de defzilj? ^ g g x„ 10)Provide existing property use A~ nr` '.~ Range Land (Agricultural, Forsestry) - r, i t - rT S Do you have knowledge of any State Highway access permits serving this property, or adjacentproperties in which you have-a prgpr,~~&(?t§ f ~no yes, if yes-what are the permit number(s) and provide copies: anC/6r permit date: ,*,,,;% ~ ~ ~ CO.' . ' Y~V rp ..r ij 12) Does the property owner own or have any interests in any adjacent property? ~'-'"-~'~ ~no ~ yes, if yes -please descdbe: Prop. Owner has 637AC in azea only 175 TB Peuni ted £or Mining. 13) Are there other existing or dedicated public streets, roads, highways or access easements bordedng or within the property? no Q yes, if yes -list them on your plans and indicate the proposed and existing access points. 14) If you are requesting agricultural field access -how many acres will the access serve? N/A 15) If you are requesting commercial or industrial access please indicate the types and number ofbusinessesond provide the floor area square footage of each. businesslland use square footage business square footage Gravel Quazry NA NO/BLD Larsen Colorado LLC NA NO/BL 175 ACRES NA NO/BL Byzantine Quazries NA NO/BL 16) If you are requesting resid ,olio/ developemen[ access, what is the type (single family, apartment, townhouse) and number of units? type number of units type number of units Homes 5 Rural Residential 5 N/A 17) Provide the following vehicle count estimates for vehicles that will use the access. Leaving the property then returning is two counts. Indicate if your counts are a or passenger ors am 6gM rocks at peak hour vowmes x of moot unn tacks at peak hour vowmea • eak hour volumes or Qaverage daily volumes. 65 130 e of single unit veNCles in excess of 30 M1 k or/aim vehitles (fielC eeuipmenl) Total eountof all vehicles 195 ~ • - ~, Previous etlltions are obsolete and may no[ be used Page 7 of 2 CBOT Form #'137 11/04