|
COLORADO DEPARTMCN7 OF THAN RTATION Isswng, .. 999
<br />
<br />o
<br />STATE HIGHWAY ACCESS PERMIT APPLICATION SEP 2 g J~4W'I.In~.,t d,au.
<br />yrt
<br />Z
<br />
<br />Insfruclions: - contact the Department of Transpo11a1ion or your local ~ovcr,~~
<br />d g@bl6~ysuinr~ aulholily.
<br />~'y
<br />h'
<br />is on oPrS~l`li{•rhf
<br />V
<br />- conlac! the issuing authority to determine what plans and otter c~ocumcnls ale required to be stlbnullyd
<br />with your application,
<br />- eontplclc this loan (sonlu questions may not apply to you) and attach all necessary documents and
<br />sullmit It to the issuing authority. Submit an application for each access requested.
<br />- it you have any questions contact thu issuing authority. Please prin! or type
<br />IJ Propully owner (Peuniuaci
<br />~ h/JD l-_l~v~ts~vn:~ ~I~'~~~~•c-7 LiL 2) AppLcml
<br />~'
<br />:Ireut address, city
<br />,~~~ W /~~ ~ ~o f is I ' % _ _ _
<br />slreW adUms:., aly
<br />_-.-_ ~ I~~ ~- _ _-
<br />56duf.2ip
<br />Cam' ,.-a~ t ~~ ,boon ll
<br />~( ~~s~. ~ • ~. o sl;tle :: xip phone!!
<br />7) /1Jdloss of propuly to bu surv d by punnil (il no nt ~/ c"' _ ,~
<br />)Z~ft:-
<br />S C 7~1 0~= ~L 1~ `~cCTU%fv ~ ~•T~~(~yU
<br />,
<br />•q Legal deacriphon of pwpurry: --
<br />Ir suLJviaon Llnck lot t~n.bnn mm~:Lr ,an
<br />~hL .fret . __- _ - ~t- L f TAI-(:r /t,` ~ ^ ~ !=
<br />:;) What el, tre,ighw:ry~`r;!; ou mglrn:.llnr :reeu;.; Iroln?
<br />G} Wh.d sWe of llw Iw,Jhway U N U S ,~ E
<br />U W
<br />-
<br />---
<br />•
<br />l> Il
<br />ili
<br />l
<br />l
<br />ll
<br />L
<br />l
<br />d
<br />l
<br />l
<br />Ih
<br />J
<br />h
<br />l'/
<br />7
<br />t
<br />li
<br />d
<br />li
<br />l
<br />n
<br />uw many
<br />u pnq,u:.u
<br />.n:.n:.:.
<br />u:n
<br />a nv.ma
<br />:vu
<br />accost.
<br />inn i
<br />a nu:uus
<br />lo
<br />e pu:.
<br />r..
<br />uu:.s 5
<br />J
<br />uw many
<br />ool is i
<br />a prin u:.u
<br />1 n l ^/
<br />' 7 0 ~ -__ teal tattle N~ E W ) Iro:n:_ J L ~ v'~ _.. _ _._.~~~ tool Icude. IJ S [ W J Imur___ 1V ~^ _ _ - _
<br />.
<br />!t) Check horn it you al a nlyuosling o
<br />' now access U temporary otter; u improvement to ewsling access U change in access use U removal of access
<br />7} What ir. fhu approRimatu Ualu you Inland to begin consp action?
<br />_ io Lis oo --_
<br />101 DO yoV hnvu 6nuwludga OI any Slaht Fhghway acwsr. penna;, set vu,g {Ina prof nn Ty, ur , rlluwnl P:upcl llc: ut which yJU have n properly inleregl
<br />~no U yes, it yes -what arc the pcnnit numbcl(sf?: and/or, permit date:
<br />I 1 J Uoxs the properly uwnur mvn or Gave any inUu u;.ls in any adjaanV properly?
<br />~no U yes, d yes -please describe:
<br />1:) Aw Ili vu other uualin~ or dudlcaled public sln:ul ;,loads, highway:. ur occurs easwm:nl: bmduring unvtlhln the properly?
<br />~no U yes, i( yes -list them on your plans and indicate llle proposed and existing access points.
<br />1~} 11 you ale wyuoslurg wmmurcial or indusln;d access plea ;u rnd:cnk: Ihu IyPn ~ •InJ numbm of buslnusau:.:md provide Ihr! IIOO! ar L'a eyU.lrll IooW[Jn OI cadl.
<br />6u5inu-,^ squan•InuLupr Lu:.luc:.r. squ.vnlonlage
<br />~-
<br />_
<br />-- ~
<br />-
<br />~
<br />r
<br />--
<br />--
<br />--
<br />~ -~- - - , -
<br />Id) l! yt,u ale ruquer.ting ::nncullura Leld occurs - hmv Innny :rcrus e~Jl the ~crur.c scrve~
<br />'~ ~O ~/•'L..'.
<br />I ) II you mo regwabng lus¢lunlial duwloponuml;:ceu s, whaUS Ihu typo (:in!Jln handy, ;rylarturonl, fownhou:.o) ahd nunl6ur of units?
<br />6
<br />number of unrt:.
<br />p/pp numhe: of anat. ryp~•
<br />
<br />_ ~
<br />IG) Provirlu Ihu Iollrnving vuhiclu count usllm:dp:. for vuhidus that will use the acw•s lJ:amng Ihu ropuUy Illnn u•h unuul is Iwo taunts. Indicnl^ it your cmuds :uu
<br />pucak hour volumes or~avenr,o d,lily volnlnc :. ~. _~~n /1i~i_ _ ~ ~r~l pn~l
<br />~ d p,r.;mlJm r.m. anJ 4aLl Inuar,
<br />~ ~ ul u.dl~ viol ImJx
<br />~ ~ • ul Ubo~ vnliclo'.
<br />i..I .;~wti
<br />n~.!>~~n.vvsGjuu +o+L,:u~veL os PlrJJ eat ~„oni Total count of .Il vehicles
<br />17} Check wdh Ihn issuing oulhm qy to Julen nine which of Ilan lolluwu:p Jocwnuuls are u:c}urrud to canplow ilia n:view of your , ppLcallon.
<br />(pLnu shuulU be nu Lugar II Ian 2J- x JG-)
<br />I e) properly m:qr iudiwling olhur occurs, LOrduring roads and slrue•IS.
<br />a) Highwayand Ulivew•ry pl:m pl olllu, I) Proposed accts Uns:gn
<br />h} Dl ainagc pL:n shuvnny impact to the highway nghl ul~vmy. ~) Farcul;mU mvnor hq+mapx including ua:emenls.
<br />c) Map and tailor Ju6ulu,g ulJdy locations Lclo:u and:au:r hJ Signing:md;Lq•uul pl.ms.
<br />duwlullmunl in and, long Ihu right-ol way. Q Tcdhr. con4ul pl:m
<br />'
<br />i U) Suhdml:juu, amine, or devulopmem plan, )) Prool ul Iiahlllly Insurance.
<br />II an access permit is issued to you it will stale the terms and conditions br its use. Any changes in the use o1 the permitted
<br />access not ccilsistene : itll the tCrrrlG ::nd COl:dlt:011 : listed on the permit may be considered a violation of the permit.
<br />-the applicant declare, under pe»olty of per,'w'y in the second degree, and any other applicable slate or lederal
<br />laws, that all inlorntalion provided on (his loan and submitted attachments arc to the best of (heir knowledge true
<br />and complete.
<br />Appllc:uNS $I naluru
<br />\
<br />~ Datu~ /~`J!
<br />r ~ -
<br />~ C
<br />
<br />~--~. I
<br />tlot
<br />=~: ~ll ~~
<br />bvltu~
<br />~~'=-'~_ ' ~ C
<br />) l/
<br />
<br />d
<br />~
<br />~
<br />r
<br /><
<br />l
<br />~
<br />II (hc~plicanl is not the oevncr of (hc property, we require ibis applicaliun also to be signed by the property owner ar Ihcir
<br />legally authorized representative (or other acceptable written evidenceJ. This signature shall constitute agreement with this
<br />aJyplicalion by all owners-ol-interest unless stated tr, writing. u a permit is author¢cd, the property owner will be listed as
<br />the perrnillcc.
<br />-
<br />-
<br />Pwpudy owner slgnalwe
<br />- Dnlu
<br />Previous odilwns may bo usuJ unlit ::upplios aro exhamlod CDOT Form tl177 9174
<br />
|