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.~ <br />~- <br />~ ,,; . <br />~ / EVAR7MENT OF HIGHWAYS <br />~~ STATE OF COLORADO <br />DIVISION OF HIGHWAYS <br />' ate of accept nce by <br />Issuing Au~tority L -2 8~brs//_ <br />DOH Form No. 137 APPLICATION FOR ACCESS APPROACH <br />Rev. September, 7997 <br />INSTRUCTIONS: Complete this form and attach all necessary documents prior to submittin tt totheissuingauthority. <br />Check with the issuing authority for what plans andotherdocuments are required to besubmi tedwith yourapplication. <br />Contact the nearest office of the Department of Highways or your local government to deterrpine the issuing authority. _ <br />Some questions may not apply to you. Contact the issuing authority for questions. <br />1. Applicant <br />Name l~ •.-.-.r C ~ phoneSa"~-~-~ <br />Address I 1 4 g ~ ~~ r~ ~c ~ a " - ~ r~ City tote i <br />2, Property Owner (~mittee~ <br />Name O~ phone <br />Address City Mate <br />3. Address of Property to be served by Permit (if it has an address) <br />4. Legal description of property Subdivision ~.~~.,~ ,Block 'T_, Lot <br />Section 'Ln i N~ ~~ ,Town hip' ~1_-~/Range ~L/ <br />5. The requested access approach uld be ocated on the ~-side o~State Highway ~ ,adistanceof <br />approximately - ot, feet from milepost L~ Precise location f the proposed access <br />approach may be required to be illustrated on plans or maps. The applicant expects to gin construction on or <br />about (Z , f . (Date). <br />6. Is there existing access to the property? Yes ~, No _. If so sh w on plan. Do other exi ting ordedicated public <br />streets, roads or highways abut the property? Yes _, No ~ List them or show o plans. <br />7. For commercial and industrial requests answer the following: <br />a. How many businesses will be served? <br />b. What types of businesses will be served and what is the floor area square footage o each. <br />B. For an agricultural field access, how many acres will the access serve? ~ <br />9. For residential development provide type(s), e.g., single family, apartments, townhouses, nd number of dwelling <br />units to be served. <br />10. What is the anticipated average daily traffic volume count for each vehicle type that ill be using this access <br />approach? (Leaving property then returning is two counts) If this question is not answered, he issuingauthoritywill <br />make an estimate based upon standard references. <br />Number of passenger cars Multi unit trucks ~ <br />Heavy single unit trucks ~- Farm vehicles 1 <br />Other, (specify) <br />11, The following documents may be required by the Issuing Authority to complete their re~iew of the application. <br />Submitted plans should be no larger than 24" x 36". <br />a. Highway and driveway plan and profile. <br />b. Complete drainage plan showing impact to the highway right-of-way. <br />c. Map and letters detailing utility locations before and alter development in and along he right-of-way of the <br />highway. <br />d. A subdivision zoning or development plan. <br />e. Property map indicating other access approaches and abutting public roads and stre ts. <br />(. Proposed access approach design. <br />12. If an access permit is issued pursuant to this application, the terms and conditions of the pert shall be based in part <br />upon the information provided by the applicant. Changes in the use of the permitted acce approach that are not <br />consistent with the terms and conditions of the permit or this application may be consi red a violation of the <br />permit. <br />THE APPLICANT HEREBY DECLARES THAT ALL INFORMATION PROVIDED ON THIS FORMII AND ANY SUBMITTED <br />ATTACHMENT(S) F E PURPOSES OF OBTAINING AN ACCESS APPROACH PERMIT AIDE TO THE BEST OF HIS <br />KNOWLEDGE RECT AND f.. IETE. ~.,~,.._ <br />SIGNATURE(Xt ( 1 ~Q_= . -L„T_ DATE 1Lr `~ -a`f <br />Relationship to property. (o r?, lessee?, please spect(y.) <br />Since an approved access approach becomes an important and integral part of the property, a require that when the <br />applicant is not the surface rights owner of the property, this application must also be signed by he surla~. c rights owner <br />or his legally authorized representative(orotheracceptablewrittenevidence)concurringinthis pplicat~~,rt.lfapermitis <br />authorized, the propert owner will be listed as the permittee. The authorized access permit may be r«corded in r' <br />county of record. ~~JJ'' _ <br />Property Owner (X) ~,~e.~.~u'L._ ~ ~ ^~'~-~-~'z-i{~ date ~ 4 . -t~ j <br />