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04/02/2009 12:27 9702527010 <br />121 Srwth Townsend <br />Montrose, CO 81401 <br />Phone: (970) 252-7000 <br />Fax: (970) 252-7010 <br />SITE ADDRESS <br />Owners Name: <br />Mailing Address: a2?1 <br />Subdivision: <br />Contractor: e <br />A:..'.. <br />Vpon the e <br />Oats c <br />r to the 7s me and qc n14 Ions (on reverse/ and ". 'ned ne Z ? <br />N <br />For appointment please contact County, Inspects: <br />. • Phone; <br />vsr,RV VVIIIIIIOI MIp1 , <br />Resitientia) (1, 2 or 3 Family).: . <br />?Field Approach <br />PLOT PLAN - Show EXISTING property Ane9, bui <br />Note: Permit will not tie ssed witliotit•dtitallei <br />PAGE 02 <br />MONTROSE COUNTY Access Permit # -A Ps? V3 `7; ? <br />ACCESS PERMIT Building Permit e <br />Parcel e <br />Fee: <br />Received By: <br />_ Phone: d. -- - 4OO <br />Vii,. - • .. .. <br />New Address Required i0 QYes (Separate form required) <br />Lot, Number. LorSize: <br />>r Phone: " •' ''. <br />?NEW ROADISTREET <br />' ?ArMrldl • <br />• ?LoCel ... <br /> <br />INT RS CTING ROAD/STREET <br />al <br />• N ollecto?•. <br />p f 1g?, L!?_ <br />Driveway, Locaw: - plo CRAP Oiametar. CMP Langlh; <br />? <br />? <br />te <br />IA. ,r <br />Embedding Material: t Embedding Depth: <br />MIA <br />Grade ® Road Surface: <br />/ <br />Access Surface: I <br />_ Sight Mums: <br />Atx:eas Spacing: <br />Access Width: 6 11 <br />X1 ?? • <br />? <br />Access Radk: Entering Sight Distance: <br />, <br />?- <br />Signage tnatalled QYee <br />1 AopMlDeeel Lanes Reqused ? pves,?(to <br />• \\ Access volume :' `?? <br />/ ` <br />ht to somas pr&A <br />Evidence of legal ri <br />dod T_ <br />Kf o Sehodulod Wert; Doles; Stwt End <br />g <br />/ <br />/? <br />Commsna' <br /> <br />lens and SPOCiftcations given above ere approved for instatlaWn: <br />z CM <br />Installed system complies with approved plans and specifications: <br />PERMR APPROVAL: <br />Coup Engineer -