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; si n , <br />nr- <br />L-anor <br />SECTION 3: TO BE COMPLETED FOR INSTALLATION OF NEW CROSSINGS ONLY <br />I low is property currently acasudT <br />r �Tkffr <br />why was accts to property not obtained from previous owner <br />Desired crossing will be _ feet () North ( ) South t0 East () West <br />Of nearest 59H AV N- IAC 0 Public ( ) Private road crossing. <br />r <br />Track is in ft cu ill ' Ntunber tracks crossed j Track is on: () Curve W Straight <br />If this application is approved, applicant agrees to reimburse the property owner for any cost <br />incurred by the property owner incident to installation, maintenance, and/or supervision <br />necessitated by this installation and further agrees to assume all liability for accidents or injuries <br />which arise as a result of this installation. Non- refundable fees in the amount of (US) for <br />document preparation,_ engineering review fee (U.S.), and= Right of Entry fee (US) <br />made payable to LandRail. LLC arc required at the time of application. In addition, fees will be <br />assessed pursuant to a written crossing agreement. This check should be attached to the <br />application. Applications submitted without the required fees will not be processed. REQUESTS <br />FOR RUSHED SERVICE (full execution within fourteen (14) days) ARE AN ADDITIONALS <br />Please note, if the submitted application and prints require review by any independent <br />environmental (HAZMAT) or other outside consultants, this review will be at applicant's sole cost <br />and in addition to the aforementioned fees. Please return fees (payable to Landitail, LLC in US <br />Dollars), application, maps and/or prints to: LandRail LLC, 50 S. Steele St., Ste. 374, Denver. CO 80209. <br />Telephone Number: (303) 398.0400, Fax Number (866) 365 -8546. <br />Once an executable road crossing license agreement is submitted to you, the agreement must be <br />fully negotiated and executed within one hundred twenty (120) days. Thereafter, the application <br />and materials will be archived and res ubmhslon (including fees) will be required. PLEASE <br />INITIAL HERE INDICATING YOUR UNDERSTANDING OF THIS POLICY: <br />Date: !0 - ?- rb <br />Signal= d. <br />Name Print 11 <br />Title: ©1 1 . f-,'ons /�a�...rw C ^ <br />Phone No.: 303 - 61? _ — 6719 <br />_ <br />RAILROAD MILEPOST <br />MGR IND & PUBLIC PROJECTS <br />MAINTENANCE <br />FOR RAILROAD USE ONLY <br />RAILROAD SUBDIVISION AAR/DOTNUMBER_ — <br />MGR TRACK MAINTENANCE <br />PHONE: PHONE: <br />SUPER1NTENDENT TRANSP SVCS APPROVAL RECEIVED: <br />MGR SIGNAL <br />PHONE: <br />WIDTH OF CROSSING WHYPH OF RR RIGHT -OF -WAY CROSSING SURFACE <br />FLAGGING PROTECTION LOCKED GATES REQUIRED AT <br />REQUIRED RIGHT - OF - WAY LINES? <br />SPECIAL PROVISIONS: ESTIMATED COST (ATTACH MATERIAL AND <br />FORCE ACCOUNT ESTIMATE) <br />E.WI *X 406631 <br />