2009-05-19_REVISION - M1980055HR (30)

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JYN-14-06 15:14 From: IUC 3033B94125 7-631 P.02/03 Job-326 R & B Form 4201 (Rev. 5/02) lags I Copy Distr:'butiou Permit 0 ?=J`/ • 1-Applicant CottuaRoad # p 1-Board of Commissioners Road pfsWot # _73 1-District Shop Payment VADeived 1-Weed Manager Permit ]Silted -L' 0 C? f- Karen )'A SW 9I SW - Application for gpeetsl ConetrueUe a Permit P?ANnJI N9 Ran Mipei County Road Department PO Box 426 Womood CO 81423 Tel (9701987-4836 Pax 1070) 327-4090 Applicant (please print or type) Contractor Performing Work Of different than Applicant) International Uranium (USA) Comorationn Name Contractor 204 West High 491 Address Address Dove Creek, Colorado 81324 City, State, Zip City, state Zip _ 970 77-2 02 _ Telephone Number(s) Telephone Number(s) June 14, 2006 Date of Application Applicant hereby requests permission end authority from the County Commissioners for a Special Construction Permit, which will entail disturbance to the County Road and right-of-way only in the area and to the extent heroin deaaribed. Applioant submits herewith for the consideration of the approval of the County Commtesione3rs, their agents and employees, a plea or proille of the proposed disruption, showing all necessary apeeifieatione and detail, as an attached part of this application. The Applicant agrees to perform the work in compliance with San Miguel County Resolution 1996-23 as passed and adopted on May 2$, 1996 durIng a regular meeting held in the Miramonte Building, in Telluride, Colorado, The Applicant, in submitting this application to which his signature 1s attached, signi&8 that he is fully aware of the conditions contained in the attached Resolution, and that he will at all times abide by those conditions, and, that he will contact the Utility Notification Center of Colorado, at 1-800.922- 1987, prior to any activity within the right-of-way. This permit shall be made available at the site where and when work is being done. Permits for private maintenance of County Roads must be renewed annually. All other permit approval& will expire on October 150, each year unless otherwise noted in the Special Conditions. The Applicant understands that no work may commence until pemiit approval is granted in writing by the road Superintendent, and the necessary bond has been posted with the County, and that no utility installation within the County Road or Tight-of-way will be allowed after October 151h or before April 1h, of any year, unless otherwise authorized by the County in writing. Fax to' Fax ?. No. of pages I r FiR??n15?P