2009-09-11_REVISION - M1997064 ‎(5)‎

• Permit No: M1997064
• IBM Index Class Name: REVISION
• Doc Date: 9/11/2009
• Doc Name: Conversion Submittal
• From: EAI
• To: DRMS
• Type & Sequence: CN1
• Media Type: D
• Archive: No

STATE HIGHWAY ACCT ?S PERMIT
Permit fee Date of transmittal Region/Section/Patrol
$300.00 2/19/2009 2 / 04 /Chuck Bennett/Patrol 23
State Highway No/Mp/Side
115 A / 24.861 / L
Local Jurisdiction
remont County
The Permittee(s);
State w C:,ioraL;u
Mark W. Davis
1.1, 13 Sherman Street, Room 621
Denver, CO 80203
Applicant: Ref No.: 3375
I?nvirotncatal Alternatives inc.
Angela Bellantoni
1107 main Street
Canon City, CO 81212

, , -? , -u» ¦
i 10-800-3 172-
is hereby granted permission to have an access to the state highway at the location noted below. The access shall be constructed, maintained and used in
accordance with this permit, including the State Highway Access Code and any attachments, terms, conditions and exhibits. This permit may be revoked
by the issuing authority if at any time the permitted access and its use violate any parts of this permit. The issuing authority, the Department and their duly
appointed agents and employees shall be held harmless against any action for personal injury or property damage sustained by reason of the exercise of
ermft.
the
.
Location: 730 feet south from milepost 25
Access t0 Provide Service to: (Land Use Code:) (Size or Count) (Units)
Gravel Pit (Mining) 10 ACRES
Additional Information:
1 F> o 10
See attached r
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MUNICIPALITY OR COUNTY APPROVAL
Required only when the appropriate local authority retains issuing authority.
Signature Print Name Title Date
?t1?v S ..!c a ?i * vi iI':S pEifiti, lulb E!!ir.ide agrees to itne tf ri!!S e is Lonciwuns dno rere!enceu dttd?rlmErlts cornalneC
herein. All construction shall be completed in an expeditious and safe manner and shall be finished within 45 days from
Initiation. -1 he permitted access snall be completed in accoraance with the iernis dna ::.o:idic;ors of the pcnrtii pfiui to
being used.
The permittee shall notify Todd Ausbun with the Colorado Department of Transportation in
Pueblo, Colorado at [phone], at least 48 hours prior to commencing construction within the State
I Highway right-of-way.
The person signing as the permittee must be the owner or legal representative of the property served by the permitted access and have full authority to
accept the permit and its terms and conditions.
ermittee Si to
rX ?? Print Name Date
712 o

his permit is not valid until signed by a duly authorized representative of the Department.
COLOIjADO DEPARTMENT OF TRANSPORTATION
Signal trr l TVW riTtt Name r ) t)I; ( Date (of issue)
rl& l` ar I ?.CesS 1 r I
Copy Distribution: Required: Make copies as necessary for. Previous e`itions are obsolete and msy not be used
1.Region 3. Staff Access Section Local Authority Inspector Page 1 of 3 CDOT Form #101 5107
2.Applicant 4.Central Files MTCE Patrol Traffic Engineer