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JL <br />"ir <br />LancraiL� <br />PRIVATE ROAD CROSSING APPLICATION <br />It is Railroad's policy that one existing road crossing must be removed for a now road crossing installation to be approved. <br />PLEASE BE THOROUGH: Incomplete applications may result in processing delays. <br />SECTION 1: TO BE COMPLETED FOR ALL CROSSINGS <br />Complete Legal Name of Applicant: Wea6 g 14e- <br />Agreement to be in the name of (if different from above): SAM A' ft& ✓C <br />Type of Applicant (please mark one): Corporation A LLC _ Individual _ Municipality_ Partnership <br />(General _Limited_) Other <br />If applicable, state /province of incorporation or organizati�o ( <br />Federal Tax Identification number (if applicable): �`� r 3 i A_/ <br />MailingAddress: bwlw(J6;�7 PV-K (JJUU5 �r9 too; LoA14 ONl; C 66 04 <br />Billing Address (if different): 1 21},44 6 A'� iI ft VE <br />Ovemight Delivery Service Address. q _ I <br />Contact Person: /DUNE f�� �1t�hoN Ti r1IGP , l fnJO Alq�lA'40 <br />Phone No.: (( 6 $4, A 3" o FaxNo.: t0b'4' o� 3 A7 <br />Email: �inZ . Johnhovi P l,. rqe -na . (_o <br />Type of Road Crossing: <br />_ Private Fart Crossing XPrivate Commercial Crossing _ Contractor's Crossing <br />Pedestrian Overpass _ Pedestrian Underpass _ other <br />_Existing Crossing —New Installation — Relocation <br />_ Permanent Use Temporary Use <br />7 U/se for Mos. _ Reconstruction <br />Crossing will be used to access 4kcoz Pfb Petry <br />Proposed WidthofCross'utg: 3C. feet <br />Desired Material for Crossing (circle one): Wood Planks /Concrete / Asphalt/ Rubber/ Other: 41V6L <br />Type of Vehicles to be driven over crossing: <br />_ Passenger Cars _ Recreational Vehicles Pickups <br />_ Farm Equipment SC Heavy Construction Equipment — Other — <br />Approximate number of daily one way trips over the crossing <br />Name ofowncr of rroporty w be serval by crossing jity 6" 4& -n <br />Address ifdifferent than above po0 to 5 Q t7 ) 60(p3) <br />Railroad being crossed. &QM kkC EM IUW#y ©J 6O Nearest Milepost ` 1,5 <br />Crossing is located in the: 4 YZ Section 3T Township & N Range ke W <br />(Example: SE 1 14 ofNW Y. Section 15, Township 39N, Range 12E) <br />In/Near the City of County 6 'A State &f -01!? /3' <br />Attach a legal description of your property to be served by the crossing and a property or county map showing the <br />location of ilia crossing: Indicate on the map the distance measured along the track betvvzzn tho cross ng and fixed <br />objects in the vicinity (i.e., bridge, culvert, railroad mile marker, public road). <br />SECTION 2: TO BE COMPLETED FOR EXISTING CROSSINGS ONLY <br />Name(s) of previous users of crossing _ <br />Crossing is currently covered by Agreement Number <br />EXM* `A" <br />40663.1 <br />