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COLORADO DEPARTMENT OF TRANSPORTATION <br />UTILITY 1 SPECIAL USE PERMIT APPLICATION please print or type <br /> <br />instructions: Complete this form, attach all requited documents, and submit it to the appropriate Permit Office. To determine which <br />documents are required, refer to the reverse side of this form and/or contact the Permit Office. You must submit all required <br />documents or the application will be deemed to be Incomplete and will not be accepted. Please do not FAX completed forms or <br />documents. <br /> <br />Permittee: property or utility owner <br />Name <br />JOS Five Rivers Cattle Feeding LLC - Colorado Beef <br />Address <br />2258 U.S. Highway 50, Lamar Colorado 81052 <br />Contact parson <br />Thane Milenski Assistant General Mana er Telephone <br />719-829.4841 <br /> <br />Applicant if other than permittee <br />Name <br />Address <br />Contact person Telephone <br />Activity Description: (fumished by permittee) <br />ity Permit <br />nstallation Adjust/relocation ? Removal ? Maintenance or existing facility <br />e, doss of trensmittant, design pressure or potential, etc.) <br />F <br />2" SDR 261PS (160 psi} Carrier Pipe w/ 24" Steel Casing, 0.375 wall thickness <br />Nature of Installation ? Longitudinal (parallel) ® Buried" ? Attach to Highway Structure #: <br />® Transverse (crossing) ? Aerial/Ground-mounted <br />Purpose It for other than Utility Permit (I.e. Special Use Permit) <br />? Landscaping ? Survey ? Spilt Cleanup ? Site Restoration <br />? Construction within tight-of-way ? Other (describe) <br />State Highway No. County Cityrrown <br />s0 Prowers Lamar <br />Location relative to SH milepost(s) <br />Proposed crossing is 274 ft east of MP sign 427 <br />Location relative to intersecting feature(s), e.g., crass street, sir. #, etc. <br />Approximatley, 1/2 mile east of U.S. HWY 50 and U.S HWY 287 Junction <br />Intended start date and planned duration of work <br />January 2011 <br />Additional remarks <br />N Pemrittee will own or operate underground ballities in State Highway rights-af-way: Indicate contact person for Telephone <br />underground location Information: 719.829.4"1 <br />Thane Milenski <br />"Notice to Excavators: You must nah7y owners or operators of underground utilities at least two (2) busirress days prior to making or beginning excavations in <br />the vicinity of such utilities, as required under Section 9-1.5-103, CRS. CALL UTILITY NOTIFICATION CENTER OF COLORADO (UNCC), 1-800-922-1987, <br />FOR MARKING OF MEMBER UTILITIES. Contact non-member utilities directly. <br />Page 1 - See Reverse Side For Additional Instructions <br />Printed 1203 editions of this form may be used until supply is exhausted. CDOT Form #1233 01104