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Home My WebLink About20091157.tiff• • C;2‘v(PAL sa SITE SPECIFIC DEVELOPMENT PLAN AND USE BY SPECIAL REVIEW (USR) APPLICATION IfFOR PLANNING DEPARTMENT USE DATE RECEIVED: RECEIPT # /AMOUNT # /$ CASE # ASSIGNED: APPLICATION RECEIVED BY PLANNER ASSIGNED: Parcel Number 0 0 4 9- 2 I - O- Q O - AO_ LO (12 digit number - found on Tax I.D. information, obtainable at the Weld County Assessor's Office, or www.co.weld.co.us.) Legal DescriptionThr;' O -c hIE%q o1' LIG%q , Section 21 Township 1? North, Range 4O West Flood Plain: Zone District: , Total Acreage: 8 e 2 , Overlay District: Geological Hazard: , Airport Overlay District: FEE OWNER(S) OF THE PROPERTY: Name: AA-rNte(rts �l��tcFE Work Phon$$# Home Phone #cID 66 2-6110/ Email Address: (a0 (o T CC_ 7 11.2*-fLAd'C Address: City/State/Zip Code /_ ) C/ ELJ p ' Name: Work Phone # ,,Address: Address: City/State/Zip Code *lame: Home Phone # Email Work Phone # Home Phone # Email Address: Address: City/State/Zip Code APPLICANT OR AUTHORIZED AGENT (See Below: Authorization must accompany applications signed by Authorized Agent) Name: ttL DI(�CCFE • Work Phone 1' ( , ' a 1 Z. Home Phone # 97C fr,k 7 E?fl.Email Address: ho 'ii ('5 e y / 3 Address: City/State/Zip Code /rg V e -t-4- / D PROPOSED USE: 0 CS3A) I (We) hereby depose and state under penalties of perjury that all statements, proposals, and/or plans submitted with or contained within the applicationere true and correct to the best of my (our)knowledge. Signatures of all fee owners of property must sign this application. If an Authorized Agent signs, a letter of authorization from all fee owners must be included with the application. If a corporatiois the fee owner, otarized evidence must be included indicating that the signatory has to legal authority tgn rte corpo tion. C�LGu i C al3fr griature: Owner or Authorized Age Date 2009-1157 October 25, 2008 • To: Weld County Planning and Zoning Department This is a letter of authorization giving my son Michael M. O'Keefe authorization to represent me and act on my behalf regarding all planning and zoning negotiations for the property located in Weld County with a physical address of: 68777 North U.S. Highway 85 Can, Colorado 80612. • Signature: Fee Owner of property Katherine E. O'Keefe Sigature: Authorized Agent Michael M. O'Keefe • Date: g1/4 Date: &S/64=T/b Pre - Application Review Request • • • Katherine E. O'Keefe 68777 N. US Hwy. 85 Sec 21, T12N, R66W Brief project narrative explaining request: The property was originally built in the 1940's as The Prairie Inn and Stateline Club and functioned as a restaurant / bar and dance hall for approximately 25 years. The Welcome to Colorful Colorado sign and US Hwy 85 turnaround are directly east in front of the subject property. The previous owners for nearly 30 years used the property as a single family residence/rental property, and boat and RV storage. Most recently the north garage was used as an upholstery shop. We would like to dove tail off the "Welcome to Colorful Colorado" sign and offer the tourists as well as commuting traffic a snack and non alcoholic beverage stop, and Colorado lottery sales store. All snacks and beverages would be available through self serving coin operated vending machines. We would also provide information to a variety of activities available in both Colorado and Wyoming in the form of maps and brochures. Small gift items, post cards etc. would also be offered. Our idea would be to convert approximately 900 sq. ft. of the north end of the building, part of the old dance hall into our store front. Approximately 400 sq. ft. of the old dance floor exists and would be refinished. The remainder of the building will remain a single family residence with 2 garages. Surrounding land uses are primarily agricultural. There is a Use by Special Review property adjacent to our property to the north west called "The Borderline Cantina". Site Specific Development Plan and Use by Special Review (USR) Questionnaire (Revised) • 1). Our proposal would be to take the existing garage space on the north end of the property, approximately 900 sq. ft. most recently used as an upholstery shop and convert it into a small store front. More specifically it would become a point of sale for the Colorado Lottery. We have met with State of Colorado dept. of Revenue officials representing the lottery sales office and can meet their criteria for opening such store. Eventually we would offer gifts and intemet service for travelers along US Hwy 85. At this time no hot beverages or food service (restaurant) is intended or planned. A single family residence and 2 garages would be maintained on the south end of the property. 2). While agriculture in Weld county is considered a valuable resource which must be protected, this 8.92 acre parcel has a long time (approx. 60 yrs.) existing improvement and low utility for agriculture use due to the small acreage. Therefore no reduction of agricultural land use for production will occur. 3). Zoning section 23-340. Uses by Special Review. While similar to our neighbor to the north west, The Borderline Cantina, this proposal offers easier, safer, paved access to the property, on level ground closer to the highway. We also hope to capitalize on the considerable amount of tourists seasonally who stop to take pictures of the "Welcome to Colorful Colorado" sign in our front yard in offering our services. 4). The surrounding land is predominantly range land owned by the Lazy D Grazing Association and individual owner / rancher Jeff Bailey. There is a single family residence on a 5 acre parcel south of the subject owned by Jeff Phillippe and an approximate 10 acre parcel to the west that is the afore mentioned Borderline Cantina owned in conjunction with the property and business directly north of the subject in Laramie County Wyoming known as "The Den a Gentlemen's Club" by the Chavez family. The proposed use of this property is consistent with that of the Borderline Cantina which offers both alcoholic and non alcoholic beverages and is the number 1 lottery retailer in the state of Colorado. • 5). A. 30 per day B. 2 C. 8am - 7pm D. None E. None F. Private passenger vehicles approximately 3000 - 4000 lb/each. 10 - 20 throughout the day. G. Within the Cheyenne Wyoming fire protection district, 5 miles north west on Terry Ranch Rd. H. Cistern holding tank approved by Weld County Health Dept. 27 January 2009. I. Existing septic system. J. N/A 6). Extensive landscaping in place. Deciduous trees and shrubs as well as a variety of pine and spruce trees and evergreen shrubs. All will be maintained at all times. 7). N/A 8). Historical natural drainage is not being changed. Drains to the north east releasing naturally. Parking areas drain naturally to the east. Soil is absorbent, consisting of gravel and top soil mix topped by prairie grass. 9). Existing improvements will be used and all landscaping is in place. 10). Little storage space will be necessary and will be contained inside. No stockpile of wastes will occur on this site with the exception of 1 small commercial dumpster currently in use and kept on the north side of the property. Identify Results • • Page 1 of 2 Account#: R0052386 WELD COUNTY ASSESSOR PROPERTY PROFILE Tax Area: 0915 Bordering County: Acres: 8.92 Township Range Section Quart. Sec. 12-66-21-0 Owners Name & Address: OKEEFE KATHERINE E 606 JACK PINE PLACE LOVELAND, CO 80538 Business/Complex: Sale Date 10/14/2008 Sale Price $290,000 Parcel#: 004921000010 Subdivison Name Block# Lot# Property Address: Street: 68777 85 HWY City: WELD Sales Summary Deed Type WD Legal Description Reception # 3587196 PT NE4NE4 21-12-66 LOT B REC EXEMPT RE -529 SITUS: 68777 85 HWY WELD 00000 Land Type Residential Land Subtotal: Bldg# 1 Abst Code 1112 Property Type Residential Improvements Subtotal: Total Property Value Land Valuation Summary Unit of Number of Measure Units Acres 8.92 Actual Value 8.92 $33,004 Buildings Valuation Summary Actual Value $62,453 Assessed Value $2,630 Assessed Value $4,970 $95,457 $7,600 Building Details Account#: R0052386 Parcel#: 004921000010 Owners Name & Address: OKEEFE KATHERINE E 606 JACK PINE PLACE LOVELAND, CO 80538 Building# 1 Built As: Exterior: Property Address: Street: 68777 85 HWY City: WELD Property Type Residential Individual Built As Detail Ranch 1 Story Year Built: Frame Masonry Veneer HVAC: 1950 Floor/Wall Furnace http://maps2.merrick.com/W ebsite/Weld/setSgl.asp?cmd=QUERY&DET=PP&pin=00492... 2/18/2009 Identify Results • • Page 2 of 2 Interior Finish: Drywall # of Baths: 1 # of Bdrms: 2 # of Stories: 1 Rooms: 6 Garage: Attached SQ Ft: Basement: Total SQ Ft: Built As SQ Ft: Roof Type: Roof Cover: Units: 960 Composition Shingle 0 3008 Detached SQ Ft: 0 0 Finished SQ Ft: 0 http://maps2.merrick.com/W ebsite/Weld/setSgl.asp?cmd=QUERY&DET=PP&pin=00492... 2/18/2009 • • 5TA1 E OF COLORADO • • • Region 4 Traffic Section 1420 2nd St. Greeley, Colorado 80631 (970) 350-2148 Fax:(970) 350-2198 DEPARTMENT OF TILANWORTAlla. Permit No. 408136 November 17, 2008 To: Michael M. O'Keefe 3241 H. Co. Road 13 Loveland, CO 80538 Dear Permittee or Applicant: 1. Please review the attached State Highway Access Permit (Form #101) and all enclosed attachments. 2. If you choose NOT to act on the permit, please return the permit unsigned. 3. If you wish to APPEAL the Terms and Conditions of the permit, please refer to the attached Form 101, Pages 2 and 3 for an explanation of the appeal procedures. 4. If you ACCEPT the Permit and its Terms and Conditions and are authorized to sign as legal owner of the property or as an authorized representative please sign and date the Access Permit form on the line marked "PERMITTEE". Your signature confirms your agreement to all the listed Terms and Conditions. 5. Provide a check or money order made out to the jurisdiction named on the next line for the amount due. Make check or money order payable to: CDOT Amount Due: $ 100.00 6. Return the Access Permit including all pages of terms and conditions along with your payment back to the Colorado Department of Transportation (COOT) at the address noted below. The Department will process and return to you a signed copy of your State Highway Access Permit. You may retain this cover letter for your records. 7. If you fail to sign and return the attached Access Permit within 60 days of the date of this transmittal letter, Colorado Department of Transportation will consider this permit withdrawn and void. 8. As described in the attached Terms and Conditions, you must make a written request to obtain a Notice to Proceed. DO NOT begin any work within the State Highway Right -of -Way without a validated Access Permit and Notice to Proceed. Use of this permit without the Colorado Department of Transportation's validation shall be considered a violation of State Law. If you have any questions, please call Tim Bilobran at (970) 350-2163. Please return Access Permit and attachments to: Region 4 Traffic Section 1420 2nd St. Greeley, Colorado 80631 jip _COLORADO DEPARTMENT F TRANSPORTATION STATE HIGHWAY HESS PERMIT Permit fee $100.00 Date of transmittal 11/17/2008 CDOT Permit No. 408136 Region/Section/Patrol 4 / 01 /20 -Ault State Highway No/Mp/Side 85 C / 309.438 / L Local Jurisdiction Weld County The Permittee(s); Applicant: Ref No.: Katherine E. O'Keefe Michael M. O'Keefe 606 Jack Pine Place 4241 N. Co. Road 13 Loveland, CO 80538 Loveland, CO 80538 970-663-2961 970-691-0812 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 Deparhnent 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 the permit. Location: This access is located on State Highway 85, a distance of 2315 north of milepost 309 on the westAeft side. Access to Provide Service to: (Land Use Code:) (Size or Count) (Units) 829 - Coffee Shop 50 ADT Additional Information: CDOT reserves the right to reevaluate this access in the future if traffic counts are found to be noticeably higher than those assigned in this permit or this location develops a history of accidents. IP MUNICIPALITY OR COUNTY APPROVAL Required only when the appropriate local authority retains issuing authority. Signature Print Name Title Date Upon the signing of this permit herein. All construction shall Initiation. The permitted access being used. The Dermittee shall notify Greeley, Colorado at (970) State Highway right-of-way. The person signing as the permittee accept the pe i and its terns the perm ttee agrees to the terms and conditions and referenced attachments contained be completed in an expeditious and safe manner and shall be finished within 45 days from shall be completed in accordance with the terms and conditions of the permit prior to Lee Ireton with the Colorado Department of Transportation in 350-2147, at least 48 hours prior to commencing construction within the must be the owner or legal representative of the property served by the permitted access and have full authority to conditions. Penn a rg 'attire Pr' t Name )9/d -/I4 - ti C. Er Date is Alav 61 / v This permit is not valid until signed by a duly authorized representative of the Department. POLORADO DEPARTMENT OF TRANSPORTATION gnature Print Name Title Date (of issue) Copy Distribution: Required: 1.Region 3.StaftAccess Section 2.Applicant 4.Central Files Make copies as necessary for. Local Authority Inspector MICE Patrol Traffic Engineer Previous editions are obsolete and may not be used Page 1 of 3 CDOT Fonn #101 5/07 • • COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS CODE NOTICE TO PROCEED CDOT Permit No. 408136 SH/S/MP 85 C / 309.438 / L Local Jurisdiction Weld County Perms): pplicant: 'Katherine E. O'Keefe AMichael M. O'Keefewp`a Cpunbl P�31�1pFF C S GREE 606 Jack Pine Place 6241 N. Co. Road 13 O `-?'7° Loveland, CO 80538 Loveland, CO 80538 E,NIED tttC6 The permittee is hereby authorized to proceed with access construction within state highway right-of-way in accordance with the above referenced State Highway Access Permit and this Notice to Proceed. This Notice to Proceed is valid only if the referenced Access Permit has not expired. Access Permits expire one year from date of issue if not under construction, or completed. Access Permits may be extended in accordance with Section 2.3(11)(d), of the Access Code. Adequate advance warning is required at all times during access construction, in conformance with the Manual on Uniform Traffic Control Devices for Streets and Highways. All construction shall be completed in an expeditious and safe manner and shall be finished within 45 days from initiation. The permittee or applicant shall notify the Department prior to commencing construction as indicated on the Access Permit. Both the Access Permit and this Notice To Proceed shall be available for review at the construction site. This Notice to Proceed is conditional. The following items shall be addressed prior to or during construction as appropriate. Municipality or County Approval (When the appropriate local authority retains issuing authority) By (X) Title Date This Notice is not valid until signed by a duly authorized representative of the Department Colorado Department of Transportation By (X) U t La- Q - (c5C Title -2Q„nn + N Date 11/24/2008 Copy istrib lion: Required: Region (original) Local Authority Inspector Lee Ireton Applicant MTCE Patrol Traffic Engineer Staff Access Section 20 -Ault Make copies as necessary for: Form 1265 8/98,6/99 COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS PERMIT CDOT Permit No. 4081 State Highway No/Mp/Side 85 C / 309.438 / L Permit fee $100.00 Date of transmittal 11/17/2008 Region/Section/Patrol 4 / 01 /20 -Ault Local Jurisdiction Weld County The Permittee(s); Applicant: Ref No.: Katherine E. O'Keefe Michael M. O'Keefe 606 Jack Pine Place 6241 N. Co. Road 13 Loveland, CO 80538 Loveland, CO 80538 970-663-2961 970-691-0812 is hereby granted permission to have an access to the state highway at the location noted below. The access shall be constructed, maintained and use accordance with this permit, including the State Highway Access Code and any attachments, terms, conditions and exhibits. This permit may be revokr 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 c appointed agents and employees shall be held harmless against any action for personal injury or property damage sustained by reason of the exercise the permit. Location: This access is located on State Highway 85, a distance of 2315 north of milepost 309 on the west/left side. Access to Provide Service to: (Land Use Code:) (Size or Count) (Units) 829 - Coffee Shop 50 ADT Additional Information: CDOT reserves the right to reevaluate this access in the future if traffic counts are found to be noticeably higher than those assigned this permit or this location develops a history of accidents. MUNICIPALITY OR COUNTY APPROVAL Required only when the appropriate local authority retains issuing authority. Signature Print Name Title Date Upon the signing of this permit the perm'ttee agrees to the terms and conditions and referenced attachments contained herein. All construction shall be completed in an expeditious and safe manner and shall be finished within 45 days from Initiation. The permitted access shall be completed in accordance with the terms and conditions of the permit prior to being used. The permittee shall notify Lee Ireton with the Colorado Department of Transportation in Greeley, Colorado at (970) 350-2147, at least 48 hours prior to commencing construction within the State 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 ac the pe t and its terms i 'conditions. Pe ke ignature ,l({ 'l L1��Nqet Pr' t Name ,-,,, � Era-- Date IAl� a This permit is not valid until signed by a duly authorized representative of he Department. COLORADO DEPARTMENT OF TRANSPORTATION Si.ire /� puR-j< -lG�— rent Name ( i_OiZ,lrk H\C;<- 11)r-2 Title � / ��Q1-/ALT I LOR- Date (of issue) tt/L'F/0 f.. Ct}py Distribution: Required: 1. Region 2.Applicant 4.Central Files Make copies as necessary for: 3.Staff Access Section Local Authority Inspector MTCE Patrol Traffic Engineer Previous editions are obsolete and may not be t Page 1 of 3 CDOT Form #101 State Highway Access Permit Form 10'1, Page 2 The following paragraphs are excerpts of the State Highway Access Code. These are provided for your convenience but do not alleviate compliance with all sections of the Access Code. A copy of the State Highway Access Code is available from your local issuing authority (local government) or the Colorado Department of Transportation (Department). When this permit was issued, the issuing authority made its decision based in part on information submitted by the applicant, on the access category which is assigned to the highway, what alternative access to other public roads and streets is available, and safety and design standards. Changes in use or design not approved by the permit or the issuing authority may cause the revocation or suspension of the permit. APPEALS 1. Should the permittee or applicant object to the denial of a permit application by the Department or object to any of the terms or conditions of a permit placed there by the Department, the applicant and permittee (appellant) have a right to appeal the decision to the [Transportation] Commission [of Colorado]. To appeal a decision, submit a request for administrative hearing to the Transportation Commission of Colorado within 60 days of transmittal of notice of denial or transmittal of the permit for signature. Submit the request to the Transportation Commission of Colorado, 4201 East Arkansas Avenue, Denver, Colorado 80222-3400. The request shall include reasons for the appeal and may include changes, revisions, or conditions *hat would be acceptable to the permittee or applicant. 2. Any appeal by the applicant or permittee of action by a local issuing authority shall be filed with the local authority and be consistent with the appeal procedures of the local authority. 3. In submitting the request for administrative hearing, the appellant has the option of including within the appeal a request for a review by the Department's internal administrative review committee pursuant to [Code] subsection 2.10. When such committee review is requested, processing of the appeal for formal administrative hearing, 2.9(5) and (6), shall be suspended until the appellant notifies the Commission to proceed with the administrative hearing, or the appellant submits a request to the Commission or the administrative law judge to withdraw the appeal. The two administrative processes, the internal administrative review committee, and the administrative hearing, may not run concurrently. 4. Regardless of any communications, meetings, administrative reviews or negotiations with the Department or the internal administrative review Committee regarding revisions or objections to the permit or a denial, if the permittee or applicant wishes to appeal the Department's decision to the Commission for a hearing, the appeal must be brought to the Commission within 60 days of transmittal • notice of denial or transmittal of the permit. PERMIT EXPIRATION 1. A permit shall be considered expired if the access is not under construction within one year of the permit issue date or before the expiration of any authorized extension. When the permittee is unable to commence construction within one year after the permit issue date, the permittee may request a one year extension from the issuing authority. No more than two one-year extensions may be granted under any circumstances. If the access is not under construction within three years from date of issue the permit will be considered expired. Any request for an extension must be in writing and submitted to the issuing authority before the permit expires. The request should state the reasons why the extension is necessary, when construction is anticipated, and include a copy of page 1 (face of permit) of the access permit. Extension approvals shall be in writing. The local issuing authority shall obtain the concurrence of the Department prior to the approval of an extension, and shall notify the Department of all denied extensions within ten days. Any person wishing to reestablish an access permit that has expired may begin again with the application procedures. An approved Notice to Proceed, automatically renews the access permit for the period of the Notice to Proceed. CONSTRUCTION 1. Construction may not begin until a Notice to Proceed is approved. (Code subsection 2.4] 2. The construction of the access and its appurtenances as required by the terms and conditions of the permit shall be completed at the expense of the permittee except as provided in subsection 2.14. All materials used in the construction of the access within the highway right-of-way or on permanent easements, become public property. Any materials removed from the highway right-of-way will be disposed of only as directed by the Department. All fencing, guard rail, traffic control devices and other equipment and materials removed in the course of access construction shall be given to the Department unless otherwise instructed by the permit or the Department inspector. 3. The permittee shall notify the individual or the office specified on the permit or Notice to Proceed at least two working days prior to any construction within state highway right-of-way. Construction of the access shall not proceed until both the access permit and the Notice to Proceed are issued. The access shall be completed in an expeditious and safe manner and shall be finished within 45 days from initiation of construction within the highway right-of-way. A construction time extension not to exceed 30 working days may be requested from the individual or office specified on the permit. 4. The issuing authority and the Department may inspect the access during construction and upon completion of the access to ensure that all terms and conditions of the permit are met. Inspectors are authorized to enforce the conditions of the permit during construction and to halt any activities within state right-of-way that do not comply with the provisions of the permit, that conflict with concurrent highway construction or maintenance work, that endanger • highway property, natural or cultural resources protected by law, or the health and safety of workers or the public. 5. Prior to using the access, the permittee is required to complete the construction according to the terms and conditions of the permit. Failure by the permittee to abide by all permit terms and conditions shall be sufficient cause for the Department or issuing authority to initiate action to suspend or revoke the permit and close the access. If in the determination of the Department or issuing authority the failure to comply with or complete the construction requirements of the permit create a highway safety hazard, such shall be sufficient cause for the summary suspension of the permit. If the permittee wishes to use the access prior to completion, arrangements must be approved by the issuing authority and Department and included in the permit. The Department or issuing authority may order a halt to any unauthorized use of the access pursuant to statutory and regulatory powers. Reconstruction or improvement of the access may be required when the permittee has failed to meet required specifications of design or materials. If any construction element fails within two years due to improper construction or material specifications, the permittee shall be responsible for all repairs. Failure to make such repairs may result in suspension of the permit and closure of the access. 6. The permittee shall provide construction traffic control devices at all times during access construction, in conformance with the M.U.T.C.D. as required by section 42- 4-104, C.R.S., as amended. 7. A utility permit shall be obtained for any utility work •within highway right-of-way. Where necessary to remove, relocate, or repair a traffic control device or public or private utilities for the construction of a permitted access, the relocation, removal or repair shall be accomplished by the permittee without cost to the Department or issuing authority, and at the direction of the Department or utility company. Any damage to the state highway or other public right-of-way beyond that which is allowed in the permit shall be repaired immediately. The permittee is responsible for the repair of any utility damaged in the course of access construction, reconstruction or repair. 8. In the event it becomes necessary to remove any right- of-way fence, the posts on either side of the access shall be securely braced with an approved end post before the fence is cut to prevent any slacking of the remaining fence. All posts and wire removed are Department property and shall be turned over to a representative of the Department. 9, The permittee shall ensure that a copy of the permit is available for review at the construction site at all times. The permit may require the contractor to notify the individual or office specified on the permit at any specified phases in construction to allow the field inspector to inspect various aspects of construction such as concrete forms, subbase, base course compaction, and materials specifications. Minor changes and additions may be ordered by the Department or local authority field inspector to meet unanticipated site •conditions. 10. Each access shall be constructed in a manner that shall not cause water to enter onto the roadway or shoulder, and shall not interfere with the existing drainage system on the right-of-way or any adopted municipal system and drainage plan. 11. By accepting the permit, permittee agrees to save, indemnify, and hold harmless to the extent allowed by law, the issuing authority, the Department, its officers, and employees from suits, actions, claims of any type or character brought because of injuries or damage sustained by any person resulting from the permittee's use of the access permit during the construction of the access. CHANGES IN ACCESS USE AND PERMIT VIOLATIONS 1. It is the responsibility of the property owner and permittee to ensure that the use of the access to the property is not in violation of the Code, permit terms and conditions or the Act. The terms and conditions of any permit are binding upon all assigns, successors -in -interest, heirs and occupants. If any significant changes are made or will be made in the use of the property which will affect access operation, traffic volume and or vehicle type, the permittee or property owner shall contact the local issuing authority or the Department to determine if a new access permit and modifications to the access are required. 2. When an access is constructed or used in violation of the Code, section 43-2-147(5)(c), C.R.S., of the Act applies. The Department or issuing authority may summarily suspend an access permit and immediately order closure at the access when its continued use presents an immediate threat to public health, welfare or safety. Summary suspension shall comply with article 4 of title 24, C.R.S. MAINTENANCE 1. The permittee, his or her heirs, successors -in -interest, assigns, and occupants of the property serviced by the access shall be responsible for meeting the terms and conditions of the permit, the repair and maintenance of the access beyond the edge of the roadway including any cattle guard and gate, and the removal or clearance of snow or ice upon the access even though deposited on the access in the course of Department snow removal operations. Within unincorporated areas the Department will keep access culverts clean as part of maintenance of the highway drainage system. However, the permittee is responsible for the repair and replacement of any access -related culverts within the right-of-way. Within incorporated areas, drainage responsibilities for municipalities are determined by statute and local ordinance. The Department will maintain the roadway including auxiliary lanes and shoulders, except in those cases where the access installation has failed due to improper access construction and/or failure to follow permit requirements and specifications in which case the permittee shall be responsible for such repair. Any significant repairs such as culvert replacement, resurfacing, or changes in design or specifications, requires authorization from the Department. Form 101, Page 3 COLORADO DEPARTMENT OF TRANSPORTATION Environmental Clearances Information Summary PURPOSE - This summary is intended to inform entities external to CDOT that may be entering the state highway right-of-way to perform work related to their own facilities (such as Utility, Special Use or Access Permittees), about some of the more commonly encountered environmental permits/clearances that may apply to their activities. This listing is not all-inclusive - additional environmental or cultural resource permits/clearances may be required in certain instances. Appropriate local, state and federal agencies should be contacted for additional information if there is any uncertainty about what permits/clearances are required for a specific activity. IMPORTANT — Please Review The Following Information Carefully — Failure to Comply With Regulatory Requirements May Result In Suspension or Revocation of Your CDOT Permit, Or Enforcement Actions By Other Agencies CLEARANCE CONTACTS - As indicated in the permit/clearance descriptions listed below, the following individuals or agencies may be contacted for additional information: • Colorado Department of Public Health and Environment (CDPHE) — General Information — (303) 692-2035 Water Quality Control Division (WQCD) (303) 692-3500 Environmental Permitting Website http://www.cdphe.state.co.us/permits.asp. • CDOT Water Quality Program Manager; Rick Willard (303) 757-9343 • CDOT Asbestos Project Manager; Julia Horn (303) 512-5519 • Colorado Office of Archaeology and Historic Preservation: (303) 866-3395 • U.S. Army Corps of Engineers, District Regulatory Offices Omaha District (NE Colorado), Denver Office (303) 979-4120 http://www.nwo.usace.armv.mil/html/od-tl/tri-lakes.html Sacramento Dist. (Western CO), Grand Junction Office (970) 243-1199 http://www.spk.usace.armv.mil/cespk-co/requlatorv/ Albuquerque District (SE Colorado), Pueblo Reg. Office (719)-543-6915 http://www.spa.usace.army.mil/req/ • CDOT Utilities, Special Use and Access Permitting: (303) 757-9654 http://www.dot.state.co.us/Permits/ Ecological Resources — Disturbance of wildlife shall be avoided to the maximum extent practicable. Entry into areas of known or suspected threatened or endangered species habitat will require special authorization from the CDOT permitting office. If any threatened or endangered species are encountered during the progress of the permitted work, work in the subject area shall be halted and the CDOT Regional Permitting Office and Regional Planning and Environmental Manager shall be contacted immediately. Authorization must be provided by CDOT prior to the continuation of work. Information about threatened or endangered species may be obtained from the CDOT website http://www.dot.state.co.us/environmental/Wildlife/Guidelines.asp or the Colorado Division of Wildlife website http://wildlife.state.co.us/WildlifeSpecies/SpeciesOfConcern/. Additional guidance may be provided by the Regional Permitting Office in the Permit Special Provisions. Cultural Resources — The applicant must request a file search of the permit area through the Colorado Office of Archaeology and Historic Preservation (CARP), Denver, to ascertain if historic or archaeological resources have previously been identified. Inventory of the permit area by a qualified cultural resources specialist may be necessary, per the recommendation of OAHP and/or CDOT. If archaeological or historical artifacts are encountered during the progress of the permitted work, work in the subject area shall be halted and the CDOT Regional Permitting Office and Regional Planning and Environmental Manager shall be contacted immediately. Authorization must be provided by CDOT prior to the continuation of work. Additional guidance may be provided by the Regional Permitting Office in the Permit Special Provisions. Contact Information Contact the OAHP at (303) 866-3395. General Prohibition — Discharges - All discharges are subject to the provisions of the Colorado Water Quality Control Act and the Colorado Discharge Permit Regulations. Prohibited discharges include substances such as wash water, paint, automotive fluids, solvents, oils or soaps. Contact Information: Contact the CDOT Water Quality Program Manager at (303) 757-9343, or the Colorado Department of Public Health and Environment, Water Quality Control Division (WQCD) at (303) 692-3500. General Authorization - Allowable Non-Stormwater Discharges - Unless otherwise identified by CDOT or the WQCD as significant sources of pollutants to the waters of the State, the following discharges to stormwater systems are allowed without a Colorado Discharge Permit System permit: landscape irrigation, diverted stream flows, uncontaminated ground water infiltration to separate storm sewers, discharges from potable water sources, foundation drains, air conditioning condensation, irrigation water, springs, footing drains; water line flushing, flows from riparian habitats and wetlands, and flow from fire fighting activities. Contact Information: The CDOT Water Quality Program Manager or the CDPHE Water Quality Control Division (telephone #'s listed above). Hazardous Materials, Solid Waste - The Solid Wastes Disposal Sites and Facilities Act C.R.S. 30-20-100, et al, and Regulations Pertaining to Solid Waste Disposal Sites and Facilities (6 CCR 1007-2), prohibit solid waste disposal without an approved Certificate of Designation (a landfill permit). The Colorado Hazardous Waste Act C.R.S. 25-15-301 et al, and the Colorado Hazardous Waste Regulations (6 CCR 1007-3) prohibit the transfer, storage or disposal (TSD) of hazardous waste except at permitted TSD sites. There are no permitted landfills or TSD sites within the State Highway Right of Way. Therefore, all solid or hazardous wastes that might be generated by the activities of entities entering the State Highway Right of Way must be removed from the ROW and disposed of at a permitted facility or designated collection point (e.g., for solid waste, a utility or construction company's own dumpster). If pre-existing solid waste or hazardous materials contamination (including oil or gasoline contaminated soil, asbestos, chemicals, mine tailings, etc.) is encountered during the performance of work, the permittee shall halt work in the affected area and immediately contact the CDOT Regional Permitting Office for direction as to how to proceed. Contact Info: Contact the CDOT/CDPHE Liaison at (303)757-9787. Environmental Clearances Information Summary Page 1 of 3 Colorado Department of Transportation November '07 Asbestos Containing Materials, Asbestos Contaminated Soil — All work on asbestos containing materials (ACM) must comply with the applicable requirements of the CDPHE Air Pollution Control Division's (APCD) Regulation 8. Disposal of ACM, and work done in asbestos -contaminated soil, must comply with the CDHPE Hazardous Materials and Waste Management Division's (HMWMD) Solid Waste Regulations. The application for any CDOT permit must specifically identify any ACM involved in the work for which authorization is being requested. Additional guidance or requirements may be specified in the permit special provisions. Contact Info: CDPHE APCD and HMWMD Regulations can be accessed via the CDPHE Environmental Permitting Website listed above. Additional information concerning clearance on CDOT projects is available from Julia Horn, CDOT Asbestos Project Manager (303) 512-5519, or Theresa Santangelo-Dreiling, Property Management Supervisor (303) 512-5524. Construction Stormwater Permit; Stormwater Discharge From Industrial Facilities - Discharges of stormwater runoff from construction sites disturbing one acre or more - or certain types of industrial facilities - requires a CDPS Stormwater Permit. Contact Information: For Utility/Special Use activities being performed in conjunction and coordination with a CDOT highway construction contract, please contact the CDOT Water Quality Program Manager at (303) 757-9343. Otherwise, contact the CDPHE Water Quality Control Division at (303) 692-3500. Website: http://www.cdphe.state.co.us/wq/PermitsUnit/wgcdpmt.html Construction Dewaterinq (Discharge or Infiltration) — Discharges of water encountered during excavation or work in wet areas may require a Construction Dewatering Discharge Permit. Contact Information: For Construction Dewatering Discharge Permits, contact the CDPHE WQCD at (303) 692-3500. Website:http://www.cdphe.state.co.us/wq/PermitsUnit/wcicdpmt.html Minimal Industrial Discharge Permit — Discharges of small quantities of wastewater or wastewater requiring minimal treatment, such as that resulting from hydrostatic testing or certain wash waters, may require a Minimal Industrial Discharge Permit ("MINDI"). Contact Info: Contact the CDPHE WQCD at (303) 692-3500. Website: http://www.cdphe.state.co.us/wq/PermitsUnit/wgcdpmt.html Municipal Separate Storm Sewer System (MS4) Discharge Permit — Discharges from the storm sewer systems of larger municipalities, and from the CDOT highway drainage system that lies within those municipalities, are subject to MS4 Permits issued by the CDPHE WQCD. For facilities that lie within the boundaries of a municipality that is subject to a MS4 permit, the owner of such facility should contact the municipality regarding stormwater related clearances that may have been established under that municipality's MS4 permit. All discharges to the CDOT highway drainage system must comply with the applicable provisions of the Colorado Water Quality Control Act and the Colorado Discharge Permit Regulations, and are subject to inspection by the CDOT and the CDHPE. Contact Information: Contact the CDPHE Water Quality Control Division at (303) 692-3500 for a listing of municipalities required to obtain MS -4 Permits, or go to http://www.cdphe.state.co.us/wq/PermitsUnit/wgcdpmt.html#MunicipalFormsGuidance. Discharge of Dredged or Fill Material — 404 Permits Administered By the U.S. Army Corps of Engineers, and Section 401 Water Quality Certifications Issued by the CDPHE WQCD - Corps of Engineers 404 Permits are required for the discharge of dredged or fill materials into waters of the United States, including wetlands. There are various types of 404 Permits, including Nationwide Permits, which are issued for activities with relatively minor impacts. For example, there is a Nationwide Permit for Utility Line Activities (NWP #12). However, depending upon the specific circumstances, it is possible that either a "General" or "Individual" 404 permit would be required. If an Individual 404 Permit is required, Section 401 water quality certification from the CDPHE WQCD is also required. Contact Information: Contact the appropriate Corps District Regulatory Office for information about what type of 404 permit may be required (information provided at top of ECIS). Contact the CDPHE Water Quality Control Division at (303) 692-3500. Erosion and Sediment Control Practices - For activities requiring a Construction Stormwater Permit, erosion control requirements will be specified through that permit. In those situations where a stormwater permit is not required, all reasonable measures should be taken in order to minimize erosion and sedimentation. In either case, the CDOT Stormwater Quality and Erosion Control Guide (2002) should be used to design erosion controls. Contact Information: The CDOT Stormwater Quality and Erosion Control Guide may be obtained from the Bid Plans Office at (303) 757-9313 or from: http://www.dot.state.co.us/environmental/envWaterQual/wgms4.asq Disposal of Drilling Fluids - Drilling fluids used in operations such as Horizontal Directional Drilling may be classified as "discharges" or "solid wastes", and in general, should be pumped or vacuumed from the construction area, removed from the State Highway Right of Way, and disposed of at permitted facilities that specifically accept such wastes. Disposal of drilling fluids into storm drains, storm sewers, roadside ditches or any other type of man-made or natural waterway is prohibited by Water Quality Control and/or Solid Waste regulations. Small quantities of drilling fluid solids (less than 1 cubic yard of solids) may be left on -site after either being separated from fluids or after infiltration of the water, provided: 1) the drilling fluid consists of only water and bentonite clay, or, if required for proper drilling properties, small quantities of polymer additives that are approved for use in drinking water well drilling; 2) the solids are fully contained in a pit, and are not likely to pose a nuisance to future work in the area, 3) the solids are covered and the area restored as required by CDOT permit requirements (Utility, Special Use, or Access Permits, etc.). Contact Information: Contact the CDOT / CDPHE Liaison or CDOT Water Quality Program Manager. Concrete Washout - Waste generated from concrete activities shall NOT be allowed to flow into the drainage ways, inlets, receiving waters, or in the CDOT ROW. Concrete waste shall be placed in a temporary concrete washout facility. Concrete washout shall only be performed as specified by the CDOT Environmental Program and shall be in accordance to CDOT specifications and guidelines. Contact Information: Contact the CDOT Water Quality Program Manager at (303) 757-9343. Spill Reporting - Spills shall be contained and cleaned up as soon as possible. Spills shall NOT be washed down into the storm drain or buried. All spills shall be reported to the CDOT Illicit Discharge Hotline at (303) 512-4446 (4H20), as well as the Regional Permitting Office and Regional Maintenance Supervisor. Spills on highways, into waterways, or that may otherwise present an Environmental Clearances Information Summary Page 2 of 3 Colorado Department of Transportation November'07 immediate danger to the public shall be reported by calling 911, and shall also be reported to the CDPHE at 1-(877)-518-5608. Transportation of Hazardous Materials - No person may offer or accept a hazardous material for transportation in commerce unless that person is registered in conformance with the United States Department of Transportation regulations at 49 CFR, Part 171. The hazardous material must be properly classed, described, packaged, marked, labeled, and in condition for shipment as required or authorized by applicable requirements, or an exemption, approval or registration has been issued. Vehicles requiring a placard, must obtain authorization and a State HAZMAT Permit from the Colorado Public Utilities Commission. Contact Information: For authorization and more info call the Federal Motor Safety Carrier Administration, US DOT for inter- and infra -state HAZMAT Registration (303) 969-6748. Colorado Public Utilities Commission: (303) 894-2868. Paleontology - The applicant must request a fossil locality file search through the University of Colorado Museum, Boulder, and the Denver Museum of Nature and Science to ascertain if paleontological resources have been previously identified. Inventory of the permit area by a qualified paleontologist may be necessary, per the recommendation of CDOT. If fossils are encountered during the permitted work, all work in the subject area shall be halted and the CDOT Regional Permitting Office and Regional Planning and Environmental Manager shall be contacted immediately. Authorization must be provided by CDOT prior to the continuation of work. Additional guidance may be provided by the Regional Permitting Office in the Permit Special Provisions. Contact Information: Contact the CDOT Paleontologist at (303) 757-9632. Working on or in any stream or its bank - In order to protect and preserve the state's fish and wildlife resources from actions that may obstruct, diminish, destroy, change, modify, or vary a natural existing stream or its banks or tributaries, it may be necessary to obtain a Senate Bill 40 certification from the Colorado Department of Natural Resources. A stream is defined as 1) represented by a solid blue line on USGS 7.5' quadrangle maps; and/or 2) intermittent streams providing live water beneficial to fish and wildlife; and/or 3) segments of streams supporting 25% or more cover within 100 yards upstream or downstream of the project; and/or 4) segments of streams having wetlands present within 200 yards upstream or downstream of the project. The Colorado Division of Wildlife (CDOW) application, as per guidelines agreed upon by CDOT and CDOW, can be accessed at www.dot.state. co.us/environmental/wild life/perm itapplication.ass. About This Form - Questions or comments about this Information Summary may be directed to Dahir Egal, CDOT Safety & Traffic Engineering, Utilities Unit, at (303) 757-9344, dahir.egal@dot.state.co.us Environmental Clearances Information Summary Page 3 of 3 Colorado Department of Transportation November'07 . State Highway Access Permit 1 Attachment to Permit No. 408136 - Additional Terms and Conditions • • • 1. If there are any questions regarding this permit, please contact Tim Bilobran at (970) 350-2163. 2. The Permittee shall refer to all additional standard requirements included with this permit and any enclosed additional terms, conditions, exhibits, and noted attachments. 3. Incorporated as part of this permit are the following: Application for Access Permit (CDOT Form No. 137) Permit (CDOT Form No. 101) and its two page attachment Exhibits: "A"- Access Plans "B"- Vicinity Map 4. This permit is issued in accordance with the State Highway Access Code (2 CCR 601-1), and is based upon the information submitted by the Permittee. This permit is only for the use and purpose stated in the Application and Permit. Any changes in traffic volumes or type, drainage, or other operation aspects may render this permit void, requiring a new permit to the be applied for based upon existing and anticipated future conditions. 5. Access construction methods and materials shall conform to the Colorado Department of Transportation Standard Specifications for Road and Bridge Construction (current edition). 6. If necessary, minor changes, corrections and/or additions to this permit may be ordered by the Department inspector, other Department representative or local authority to meet unanticipated site conditions. Changes may not be in violation of the State Highway Access Code. All major changes to the plans must be approved in writing by the Department prior to commencement of any work on or within the State Highway right-of-way. All workers within the State Highway right-of-way shall comply with their employer's safety and health policies/procedures, and all applicable U.S. Occupational Safety and Health Administration (OSHA) regulations - including, but not limited to the applicable sections of 29 CFR Part 1910 - Occupation Safety and Health Standards and 29 CFR Part 1926 - Safety and Health Regulations for Construction. At a minimum, all workers in the State Highway right-of-way, except when in their vehicles, shall wear the following protective equipment: * Head protection that complies with the ANSI Z89-1-1997 standard; * At all construction sites or whenever there is a danger of injury to feet, protective footwear that complies with the ANSI Z41-1999 standard will be worn; * High visibility apparel as specified in the Traffic Control provisions of this permit (at a minimum, ANSI/ISEA 107-1999, Class 2). Where any of the above -reference ANSI standards have been revised, the most recent version of the standard shall apply. 7. This permit is subject to revocation due to: I) Noncompliance with the provisions of this permit; 2) Abandonment; 3) Supersedure by new permit covering the same installation; or 4) Conflict with necessary planned highway construction and/or improvements. The Permittee shall promptly terminate occupancy State Highway Access Permit 2 Attachment to Permit No. 408136 - Additional Terms and Conditions • • • upon notice of cancellation of the permit from the Department, unless a new permit is applied for and granted. 8. Reconstruction and improvements to the access may be required when the Permittee has failed to meet the required design and/or material specifications. If any construction element fails within two years due to improper construction or material specifications, the Permittee is responsible for all such repairs. 9. The Department retains the right to perform any necessary maintenance work in this area. 10. Backing maneuvers within and into the State Highway right-of-way are strictly prohibited. All vehicles shall enter and exit the highway right-of-way in forward movement. Backing into the right-of-way shall be considered a violation of the terms and conditions of this access permit and may result in revocation of the permit by the Department and/or the issuing authority. 11. All costs associated with the maintenance of this access are the responsibility of the Permittee. This includes design, construction, signing and striping, utility relocation, testing of materials, and inspections. 12. Landscaping and site construction shall not obstruct sight distance at any State Highway access point. Landscaping within the State Highway right-of-way requires the Permittee to obtain a CDOT Landscaping Permit from the Traffic/Access Section. The access permit does not authorize that activity. Irrigation of features within the right-of-way may require the Permittee to install a subsurface drain in accordance with CDOT Standard M-605-1 or other approved system. The Permittee shall contact Linda McWilliams at the Greeley Traffic Office, (970) 350-2147 to obtain the Landscaping Permit. 13. Routine, periodic maintenance and emergency repairs may be performed within the State Highway right-of-way, under the general terms and conditions of the permit. Any significant repairs such as culvert replacement, resurfacing, or changes in design or specifications, will require written authorization from the Department. The Department shall be given proper advance notice whenever maintenance work will affect the movement or safety of traffic on the State Highway. In an emergency, the Department Region Office and the State Patrol shall immediately be notified of possible hazards. 14. If highway right-of-way fence exists or is proposed, the Permittee must contact Tim Bilobran at the Greeley Traffic Office, (970) 350-2163, prior to removal or installation. 15. The access shall be maintained at 18 feet wide with a 28 foot radii. 16. Surfacing of the access shall be maintained as per Exhibit "A". 17. The access shall be maintained in a manner that will not cause water to enter onto the roadway, and will not interfere with the existing drainage system within the State Highway right-of-way. Drainage to the State Highway right-of-way shall not exceed historical rate of flow. 18. The maintenance of the access and/or further development of this property shall not negatively impact adjacent nearby properties. Correction of the problem and cost resulting from damages shall be borne by the Permittee. State Highway Access Permit 3 Attachment to Permit No. 408136 - Additional Terms and Conditions • • • 19. The Department inspector may suspend any work due to: 1) Noncompliance with the provisions of this permit; 2) Adverse weather or traffic conditions; 3) Concurrent highway construction or maintenance in conflict with permit work; 4) Any condition deemed unsafe for workers or the general public. The work may be resumed upon notice from the Department inspector. 20. It is the responsibility of the Permittee to determine which environmental clearances and/or regulations apply to the project, and to obtain any clearances that are required directly for the appropriate agency prior to commencing work. Please refer to or request a copy of the "CDOT Environmental Clearance Information Summary" (ECIS) for details. The ECIS may be obtained CDOT Permitting Offices or may be accessed via the CDOT Planning/Construction-Environmental Guidance webpage at http://www.dot.state.co.us/environmental/Forms/asp. FAILURE TO COMPLY WITH REGULATORY REQUIREMENTS MAY RESULT IN SUSPENSION OR REVOCATION OF YOUR CDOT PERMIT, OR ENFORCEMENT ACTIONS BY OTHER AGENCIES. ALL discharges are subject to the provisions of the Colorado Water Quality Act and the Colorado Discharge Permit Regulations. Prohibited discharges include substance such as: wash water, paint, automotive fluids, solvents, oils or soaps. Unless otherwise identified by CDOT or the Colorado Department of Public Health and Environmental (CDPHE) Water Quality Control Division (WQCD) as significant sources of pollutants to the waters of the State, the following discharges to storm water systems are allowed without a Colorado Discharge Permit System Permit: landscape irrigation, diverted stream flows, uncontaminated ground water infiltration to separate storm sewers, discharges from potable water sources, foundation drains, air condition condensation, irrigation water, springs, footing drains, waterline flushing, flows from riparian habitats and wetlands, and flow from fire fighting activities. ANY OTHER DISCHARGES, including storm water discharges from industrial facility or construction sites, may require Colorado Discharge Permit System permits from CDPHE before work begins. For additional information and forms, go to the CDPHE website at: http://cdphe.state.co.us/wq/PermitsUnit/wqu. 21. The Permittee is required to maintain all culverts found at this location and shall provide for proper side slopes. 11/03/2868 17:16 978-350-2207 OllUI UIL 5Artlr rsm= OUG! • • • COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS PERMIT APPLICATION Issuing authority application aelIid?t(111) Instructions; - Contact the Colorado Dspertment of Trnrspotlation(CDOT) or your local government to determine your Issuing authority, • Contact the issuing authority to determine what plans and other documents are required to be submitted with your application. - Complete this form (some questions may not apply to you) and attach all necessary documents and Submit it to the issuing authority. Please print - Submit anapplication for each access affected. or type - If you have any questions contact the Issuing authority • For additional information sea CDOT's Access Management website atMttsllwyM' dotetete co us/AccessPermlhrindsz.htm 1) ProelirtY 1Ti-{Lel7 Owner (Psr Ittee) c.A' E. e • DI KEEF6 2),A ent for permittee(If different from property owner) /I'► 1e-iigcI- fi'i • O'Ke-c-c6 Sataddress //1� � trSob T ek f3/46"/ppL4es Mailing address (a?^•// 11 6.4P. /3 City, state & zip Z2v�xa Coo g0&38 Phone ft City, state & zip gib la(o3 27hi Loy M'-' Co ?0s3r C$12 --mail Phone a (required) V701111 address E -mall address if available A M/4 -114 -a -,tog EFGQ,CazKAA6[i0W1c-S,C.aWt 3) Address of property to be served by permit 69777 Us 4fcua (required) 9 ? ,t dal -o. Sol la/2 4) Legal description of property: If wit4 scanty eubtlMebn jurisdictional limits of Municipality, city and/or County, which one? block lei :moles e� ` I I iowmhu 1 n A / I woe / (Q W 6 c' 1 I. d'iv e) Whet S Highway uyours tr%/ // ue�8 q access from? L1 6) What side of the highway? N S ■ i�--s E t y' W 7) Haw ppost? / 'many feet is the psloeedd a access from the n�enarrest mile C747Q feet'NOSOE�W)from:fl 30 HIow many feel Is the _proposed access from the nearest cross street? a° �ck VV aeEaNgs•E•W)from: 1212 8) what Is the seproxl t date you intend to begin construction? 6YCI3r/NCB /3Ua-43iy-i6 9 Check here If you are requesting a; new access ©temporary access (duration anticipated( ) e change in access use 7removal of access Improvement to existing access �ralocation of an existing access (provide delal ) 10) Provide existing property use 5044 &G. F ) £ O6n4ae 5r oe � c 11) Do youu ye knowledge ofa State Highway access pdrmits serving this property, or adjacent properties in which you have a property interest? no ©yes, if ye whatare the permit number(s) and provide Copies: and/or, permitdate: 12) Do es alpropergiwner own or have any Interests in any adjacent properly? no yes, If yes • please describe; 13) Are tho other existing or dedicated public streets, roads, highways or access easements bordering or within the property? no © yes, if yes - list them on your plans and indicate the proposed end existing access points. 14) If you are requesting agricultural field access - how many acres will the access serve? N/q IS) if you are requesting commercial or industrial access please indicate the types and number of businesses and provide the floor area square footage of each. businesseand use square footage business square footage 1Pr/dE� oFrs61cP l9° I Is) if you are requesting residential deveiopement access, what is the type (single family, apartment, townhouse) and number of unite? type number of units type number of units r I l 17) Provide me following vehicle count estimates for vehicles that will use the access. Leaving the property then returning Is two counts, arj IInynyd,�lbate if your counts are peak hour volumes or MI average daily volumes. a of penr C and f;ht buds en punk hour volumee Z s of mulu um t ii peek hour volume a oingo unitveh Ioeh etoeve M.ba II al farm vnNkyti4l0 soulpmcm) Total ocourt of all vehicles cgs Previous Selene are obsolete and may not be used Page t of 2 ODOT Form MHT 12/04 • • • 18) Check with the issuing authority to detemrine which of the following documents are required to complete the review of your application. a) Property map indicating other access, bordering roads and streets. e) Subdivision, zoning, or developmentplan. b) Highway and driveway plan profile. f) Proposed access design. c) Drainage plan showing Impact to the highway right-of-way. g) Parcel and ownership maps including easements. 4 Map and letters detailing utility locations before and afar tl) Traffic studies, development in and along the dghtaf-way. I) Proof of ownership. 1 • It is the applicant's responsibility to contact appropriate to their activities. Such clearances may include Corps of permits, or ecological, archeological, historical or cultural Information Summary presents contact Information for agencies prohibited discharges, and may be obtained from Regional CDOT Planning/Construction-Environmental-Guidance webpage 2- All workers within the State Highway right of way shall procedures, and all applicable U.S. Occupational Safety limited to the applicable sections of 29 CFR Part 1910 - Occupational - Safety and Health Regulations for Construction. Personal protective equipment (e.g, head protection, footwear, respirators, gloves, etc.) shall be worn as appropriate for minimum, all workers in the State Highway right of way, except protective equipment: High visibility apparel as specified accompanying the Notice to Proceed related to this permit protection that complies with the ANSI Z99.1-1997 standard; Injury to feet, workers shall comply with OSHA's PPE requirements and 1926.96. If required, such footwear shall meet the requirements Where any of the above -referenced ANSI standards have apply. 3- The Permittee is responsible for complying with the Revised under the American Disabilities Act (ADA). These guidelines use of a defined pattern of truncated domes as detectable can be found on the Design and Construction Project Support chttp:l/www.dot.state,co,us/D_esienSgpporth, then click agencies and obtain all environmental clearances that apply Engineers 404 Permits or Colorado Discharge Permit System resource clearances. The CDOT Environmental Clearances administering certain clearances, information about CDOT Utility/Special Use Permit offices or accessed via the httnd/www.dot.state.co.us/envlronmentallForms.asr2. comply with their employer's safety and health policies( and Health Administration (OSHA) regulations - including, but not Safety and Health Standards and 29 CFR Part 1926 high visibility apparel, safety glasses, hearing protection, the work being performed, and as specified in regulation. At a when in their vehicles, shall wear the following personal In the Traffic Control provisions of the documentation (at a minimum, ANSI/ISEA 107-1999, class 2); head and at all construction sites or whenever there is danger of for foot protection per 29 CFR 1910.136, 1926.95, of ANSI 241.1999. been revised, the most recent version of the standard shall Guidelines that have been adopted by the Access Board define traversable slope requirements and esoribe the warnings at street crossings. The new Standar Plans and web page at: on Design Bulletins. If an access permit is issued to you, it will state the terms and conditions for its use. Any changes in the use of the permitted access not consistent with the terms and conditions listed on the permit may be considered a violation of the permit. The applicant declares under penalty of perjury in the second degree, and any other applicable state or federal laws, that all information provided on this form and submitted attachments are to the best of their knowledge true and complete. I nderstand receipt of an access permit does not constitute permission to start access construction work. A nes n tuns 1 Print name ill ltif-.gL of(CECIL Dale livov I 0 8 ---, If the applicant is not the owner a he property, we require this application also to be signed by the property owner or their legally authorized representative (or other acceptable written evidence), This signature shall constitute agreement with this application by all owners -of -interest unless stated in writing. If a permit is issued, the property owner, In most cases, will be listed as the permittee. Property rt/erslgndture ` ,;,Print e. Print name / �jt/Ek/NG C / sF Date /A/uv/O Previous editions ern nbeolate and may not be used Page 2 or 2 0007 Form alai 12/04 ra-42 • • y a 0 wl 41 . c O as °0 u •«— t t" :5 1.... a V Ri o L u . u4o c Qp G G" ci . = co y L U �y L ,Q °° a`° a ro-na w, 1, u yasEl dto L CI 4..., v cd d w u y 7 w u a C O O u q d en I o v .,. L4' 0 y yy cn iria i h L 'C L 'd v L U iUU b^A ❑ H a .5 t. ' -t cd e I u to q "" u O Cl.) .g q Q bD .q CI CI n a a .ct P. 7 U L u CL b -4.0•-r,, uw cC L b. 7 L O. Cd n w U A In d L 5 � O ro .a en • a L w o z ca ca m c 7 4 2 -G f DELORME Vicinity Map for Access Permit #408136 Francis E Warren A F B Orchar Valley Carr Burnham Field Data use subject to license. © 2005 DeLorme. Street Atlas USA® 2006. www.delorme.com Ste Locator Mile Hi Simpson Mesa • Street Atlas USA® 2006 Scale 200,000 3.16 mi Data Zoom 0-0 Hello