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Home My WebLink About20200122.tiffThis Site Plan Review (SPIN) application has been submitted in conjunction with a Resubdivision (RESUB) application and Change of Zone (COZ) application. All three applications are expected to be reviewed in conjunction with one another. Please refer to pre -application case no. PRE 19-0076. CHANGE OF ZONE (COZ) APPLICATION FOR PLANNING DEPARTMENT USE RECEIPT/AMOUNT # 1$ APPLICATION RECEIVED BY DATE RECEIVED: CASE # ASSIGNED: _ PLANNER ASSIGNED: Parcel Number 0 9 6 1- 9 9- 3 - 9 0- 9 8 7 (12 digit number - found on Tax I.D. information, obtainable at the Weld County Assessors Office, or wvvvv.co.weld.co.us) (Include all lots being included in the application area If additional space is required, attach an additional sheet) Existing: L3 SE4SW4 9-5-65 Union Colony Lands Sub Proposed_ Li at RESUB ci L3 SE SW4 9-S-65 Legal Description pow Colariy Lads Sub _, Section 9 , Township 5 North, Range 65 West Property Address (If Applicable) 470 E. 18th Street, Greeley, CO 80620 Existing Zone District: R-1 Proposed Zone District: C-3 Total Acreage: Existing: 4.8 Proposed #/Lots: 2 Proposed: 1 26 Union Colony Lands Average Lot Size: 2.4 Acres Minimum Lot Size: 1.26 Acres Proposed Subdivision Name: Resubdivision FEE OWNER(S) OF THE PROPERTY Of additional space is required, attach an additional sheet) Name: Miller. Janna R. & Daniel B. Work Phone # (970) 405-4660 Home Phone # Email Address rndanjan yaol.co i Address: 470 E. 18th Street City/State/Zip Code Greeley, CO 80631 APPLICANT OR AUTHORIZED AGENT (Sae Below Authorization must accompany applications signed by Authorized Agent) Name: Kelsey Bruxvoort - AGPROfessionals Work Phone # (970) 535-9318 Rome Phone # Email Address kbruxvoort@agpros.com Address: 3050 67th Ave. City/State/Zip Code Greeley., CO 80634 UTILITIES - Water Sewer: Gas: Electric: Phone: Existing well & City of Greeley Proposed septic & City of Greeley ATNIOS Energy Xcel Energy N/A DISTRICTS: School: Greeley 6 School District Fire: Western Hills Fire Protection District Post Office: Greeley I (We), the undersigned, hereby request hearings before the Weld County Planning Commission and the Weld County Board of County Commissioners concerning the proposed Change of Zone for the following described unincorporated area of Weld County, Colorado: I (We) hereby depose and state under penalties of perjury that all statements, proposals, and/or plans submitted with or contained within the application are 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 corporation is the fee owner, notarized evidence must be included indicating the signatory has the legal authority to sign for the corporation. OR. biSti CIA'S we. L. & 60.)M10100 - YAM Signatu Owner or Authorized Agent Date Signature: Owner or Authorized Agent Date AGPROfessionals DEVELOPERS OF AGRICULTURE April 23, 2019 To Whom It May Concern: Daniel Miller is contracted with AGPROfessionals for all permitting, planning, engineering, and regulatory work relating to Weld County land use permitting. APROfessienals is authorized to represent and request the release of all records necessary on behalf of Daniel Miller. We respectfully request that all correspondence be directed to AGPROfessionals. Sineerelyi, Daniel Miller Signature: AnAlLsdir Date: ENGINEERING, PLANNING, CONSULTING & REAL ESTATE 3050 67th Avenue is Greeley, CO 80634 970.535.9318 /office • 970.535.9854 / fax • wwuw.agpros.conn AGPROfessionals DEVELOPERS OF AGRICULTURE June 14, 2019 To Whom It May Concern: Janna Miller is contracted with A PR fcssionals for all permitting, planning, engineering, and regulatory work relating to Weld County land use permitting, AUP Ofessionals is authorized to represent and request the release of all records necessary on behalf ofJanna. Miller. We respectfully request that all correspondence be directed to AGPROfessionals. fessionals. Sincerely, i' Janna Miller /rit %,,,n et i-gnatureiaiddiiitireel a ti C, Date: ENGINEERING) PLANNING, CONSULTING & REAL ESTATE 3050 67th Avenue • Greeley, CO 80634 970.535.9318 / office ■ 970.535.9854 / fax ■ www agpres,coni AG PROfessionals DEVELOPERS OF AGRICULTURE WELD COUNTY CHANGE OF ZONE (COZ) QUESTIONNAIRE Prepared for Daniel and Janne Miller This Change of Zone application has been submitted in conjunction with a Resubdivision application and Site Plan Review application. All three applications are expected to be reviewed in conjunction with one another. Please refer to pre -application case no. PRE19- 0076. Introduction Daniel and Janne Miller are requesting a Change of Zone to the C-3 (Business Commercial) Zone District for Lot .l of the proposed Resubdivision submitted with this zoning request. The Resubdivision will split the existing parcel described as Lot 3 of the Southeast Quarter of the Southwest Quarter of Section 9, Township 5 North, Range 65 West of the 6th P.M., of the Union Colony Lands subdivision, according to the 1871 Map of the Colony Lands as laid out by the Union Colony of Colorado and recorded in 1891 at reception no. 39743. The subject property is located at 470 E. 13th Street, Greeley, CO 80631. The associated parcel number is 0906109300087. The subject property was zoned E <Estate) by the Board of County Commissioners in 1962 as part of a sweeping re -zoning of much of the surrounding area, zoning case no. Z-23*. It is our understanding that when the Estate Zoning District was vacated from the Weld County code, the zoning of the subject property defaulted to the R-1 (Low Density Residential) Zone District. The historical use of the subject property, however, has not been residential. The site is currently irrigated for the production of hay and contains a 4,800 SF equipment building. The Millers wish to retain the existing hay farming, have the ability to build their personal residence on -site and use the existing building for repair of diesel vehicles. The Resubdivision will split the 4.81 -acre parcel into one 1.26 -acre lot <Lot 1) and one 3.55 - acre lot <Lot 2). Lot 2 will remain in the R-1 Zone District to allow the construction of a residence in the future. This Change of Zone is requested for Lot I for the C-3 (Business Commercial) Zone District. The Site Plan Review application also submitted with this zoning request is for the proposed diesel repair business which will operate out of the existing shop located on Lot 1. Included with the application materials for reference are a property map, existing zoning map, Union Colony Lands Subdivision Plat and Commissioners Records for zoning case no. Z-23*. 1, How is the proposed rezoning consistent with the policies of the Weld County code, Chapter 22? If the proposed rezoning is not consistent with the Comprehensive Plan, explain how the proposed rezoning will correct what the applicant perceives as faulty zoning, or how the proposed rezoning will fit with what the applicant perceives as the changing conditions in the area. ENGINEERING, PLANNING, CONSULTING & REAL ESTATE 3050 67th Avenue, Suite 200 ❑ Greeley, CO 80634 970.535.9318 / office ❑ 970.535.9854 / fax ❑ www.a.gpros.com Page 2 of 4 The proposed rezoning is consistent with the Weld County Comprehensive Plan in accordance with the following sections designated in the Weld County Code: Sec. 22-2-100. Commercial development Goals and Policies. • 22-2-100. A. Ca Goal 1. Promote the location of commercial uses within municipalities, County Urban Growth Boundary areas, Intergovernmental Agreement urban growth areas, growth management areas as defined in municipal comprehensive plans, Regional Urbanization Areas, Urban Development Nodes or where adequate services are currently available or reasonably obtainable. m 22-2-100. A.2. C. Policy 1.2. Encourage new commercial development within existing commercial areas. • 22-2-100. E. h. C•Policy 5.1. Consider the compatibility with surrounding land uses and natural site features. 2. How will the uses allowed by the proposed rezoning be compatible with the surround land uses? Include a description of existing land uses for all properties adjacent to the subject property. Uses permitted in the C-3 (Business Commercial) Zone District will be compatible with the surrounding land uses. With the 1962 zoning of the area occurring on such a large scale, the assigned districts were not necessarily accurate to the site -specific conditions of all properties included in case no. Z- 23*. The findings and resolution considering the 1962 zoning of the area, case no. Z-23*, states: "Whereas, the Board of County Commissioners of the County of Weld is of the opinion that zoning of the described area will promote the health, safety, morals, convenience, order, prosperity and welfare of the present and future inhabitants of said area." While the property is zoned R-1 (Low Density Residential), the historical use of the subject property has not been residential. The site is in an urbanizing area near the City of Greeley, located on E. 18th Street approximately one half mile east of Highway 85. E. 18th Street is a portion of the Highway 34 business route that is maintained by the Colorado Department of Transportation (CDOT). The intersection of E. 18th Street and Highway 85 is designated as an Urban Development Node. Since the initial zoning of the area, several of the included properties have been rezoned for commercial use, particularly along E. 18th Street. The proposed zoning meets the changing conditions of the area. E. 18th Street is a busy corridor along which there are many established commercial and industrial uses. The proposed zoning is also consistent with the City of Greeley's Comprehensive Plan. The subject property is located in the Suburban Neighborhoods area within three -hundred and fifty feet of a Mixed -Use High Intensity area according to the Land Use Guidance Map. Descriptions of the Suburban Neighborhood and Mixed -Use High Intensity areas as outlined in the City of Greeley's Comprehensive Plan are listed below: Page 3 of 4 • Suburban Neighborhood. Overview. Complete Neighborhoods. A range of supporting non-residential uses (commercial, retail, employment, civic, etc.). 0 Suburban Neighborhood. Description. Some non-residential supporting uses may be found within these neighborhoods; however, most are likely to be located along adjacent commercial corridors or within neighborhood regional centers. • Mixed -Use High Intensity. Description. Supported uses include residential, commercial, retail, office and civic/institutional uses. 3. Will the property use a septic system of public sewer facilities? There are no sanitary sewer service lines in E. 18th Street north of the site. Septic systems are proposed for Lots 1 and 2 until a wastewater main is extended adjacent to the subject property, sanitary tap(s) are purchased, and appropriate infrastructure installed. The City of Greely Can Serve Letter received for water and sanitary sewer service is included with the application materials. Subject to conditions outlined in the letter, Greeley can provide water and sanitary sewer service to the subject property. 4. Who will provide adequate water, including fire protection, to the property? Bottled water and portable toilets will be provided for the diesel repair shop located on Lot 1 as there will be two or less full-time employees and less than ten customers/visitors per day. If thresholds requiring a water tap are reached by the business or if desired by the property owner(s), water can be obtained from the city of Greeley. There is currently a 18" waterline installed in E. 18th Street adjacent to the subject property. A Greeley water tap is expected to be purchased for Lot 2 at the time a residence is built. The City of Greely Can Serve Letter received for water and sanitary sewer service is included with the application materials. Subject to conditions outlined in the letter, Greeley can provide water and sanitary sewer service to the subject property. 5. Does the property have soils with moderate or severe limitations for construction? If yes, the applicant shall submit information which demonstrates that the limitations can be overcome. The Geology Report prepared for this request does not indicate moderate or severe soil limitations for construction. The Geology Report is included in the application materials. 6. Is the road and/or highway facilities providing access to the property(ies) adequate to meet the requirements of the proposed zone district? If not, the applicant shall supply information demonstrating the willingness and financial capability to upgrade the road and highway facilities. The existing road facilities providing access to the property are adequate to meet the requirements of the C-3 (Business Commercial) Zone District. E. 18th Street is a portion of the Highway 34 business route that is maintained by the Colorado Department of Transportation <CDOT). CDOT access permit no. 416057 was issued for the existing shop during the building Page 4 of 4 permitting process. A new CDOT access permit application has been submitted for the uses proposed with the Site Plan Review. 7. Is the change of zone area located in a Flood Hazard Overlay District? The subject property is not located in a Flood Hazard Overlay District. 8. Is the change of zone area located in a Geologic Hazard Overlay District? The subject property is not located in a Geologic Hazard Overlay District. 9. Is the change of zone area located in the AP (Airport) Overlay District? The subject property is located in the Greeley -Weld Airport Overlay District. All applicable rules relating to the overlay district will be observed. 12 -;OZ 169 -00:3915 COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS CODE NOTNCE TO PROCEED CDOT Perin t No. 416057 SR/MP 34D/ 12122 1 R. Local Juirbdiction Weld Com Permittee(s): 'alma Miller 3403 Windmill court Evans, CO 80620 Applicant: The perrnittee is hereby authorized to proceed with access construction within state highway right-offway 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 expinxi. Access Permits expire one year from dale of Issue if not under construction, or cor pieted. 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 sale manner and shall be finished within 45 days from initiation. The perrnittee 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) This This Notice is not valid until signed by a duly authorized representative of the Department Colorado Department 0 Transportation By (X) a r Title arrn+ Date Date 5/5/2016 Copy RequTr : Reg k3n (tinal) Applicant Staff Access Section Make dies as necessary for Local Authority Inspector Bye MICE Peal Traffic Engtneet 25 -East Greer Form 1265 n.' 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The at shall cQrrr-aJavc a n.tiin inecl use in !r r: a iith ii i• ni ta*,. (ncituding iiho Stets HigisQviay► Ac�i a a and any atca Grier i tonne co zind a ibiLs. accordance _. � � � � This ,pe�rtttit may be �td y the i utria aulhor)jy at sly lima th ps rri ed Dcc and re; 0,5-3 vio'ata any pars or this pent The i ukij. utho i , the Department and their duty fr appei tad agent*, and erop shill ll tv a heir! hanniaas against any ac ► on tor izonsii Injuryo property dame er Y ! e ..YY r yerpit. ■ i—T - - - -• • Itrr t a - ■A1i•a. r,►a .a rar...aMia a - _ tJ •� � _ n y '�r�� a T•'r'Yi■v {i.—K.Ir r i•�..•ii•.JIiT .._w• / a�y jf S �y m• Tir 'a 7 /'« • �`r ! +� -' a n'l.. r••_•YI� -`.*�. .J,:.IJ i a :v rr a r •.yar.n. 1 a .. i• ... a Loc''k�l+• bn: ! Ea.' SSri i-s to 'Le ilgc +54•a�d on State 1 :Fig -ref tile', �.lY t-I.:^V'9of� a 'cik.`�,ai YLiY■`�4r ,I41 2 m at ao f 1,313 Peg south/not ifa�r.Yawr. f • rr-ter.-••er1W- i r r a •• w Ydm� a ••r a .1'-c s V.. c. 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Tv Rti COUNTY APPROVAL �.--- s3pauury I rye •ear.■Y �` — ) Z'i iaar. l a i R / • s: R � . qr�.F Tr•T �� 1'f "frNYi Yua • ■Yl.aJ41■r� at • -'�-Tr•■ aresr9.i• 'aA-•+s"•>rST.t�4xsa - -rne u -f s��iifap 's•-s'r'.. a•a r -:4n r.rl/ a'"2“I '.��ii'. ra trantr�r...�-. to Upon the signing this permit the rmittee agrees to the turns n conditions aI tr •mf L�J .+a' f"f. �' rf' t s � .Ir f: arts herein. All construction shall he completed in an expeditious and safe manner and shall bet-mi.-shed within 45 days from Initiation. The permitted access shall he completed in accordance t1 terms and conditions with rs of the permit prior to b cIng used. The perriatez shall fiaa(+rL Bruce Barnett is:: �` r�ie yEta D r�j�apa ter{ ttl , Tre ali {y�� !Z `4'. aa'.. i• �ar■ Y at � 1�■'�$ �441r�� 1 �, I i� ^f rrf�� at Inst. , 7� r M.,� � •■R �i • ��! �■��i � � y� � .9j AM�d•+ne ��.�� +y►��sMa� � � a"- �42 hours c rE a��v �1 �+r+��f �� 4 4 y rice Wm igit .aa ecartg con- aiYPilon withinthe Stale Highway irightedaftvoy. 1'I tic! put4Lin s crtirrg es Gala ii6unitt+se IMUS t b ,, thy. Willer 07 iC1l lepu,s n ally of ihn pr#p t . il6nood by the permitted acciass and tavir aril alit uray ID nti t thu wilmit alai Is Mints and conditions, -�!1 j, � n Mall, UMW +■Ta -• a so as■.flat •J•,,a `aa a r. -_Ir Pal .n sig\P X ,- l 0 i--•••••••••PSN-i-anainnire Y crew +, r ■ e Pit? ?, ire! a SIN es.ara wan k p ;it ia�a�'a4aaa'e• a"mkranthe _}}1.'..>zs fn x. w9H � av s..m a.rn.w +r.flaakr.,-•a.•7, / rte... V_ y •aarwi daa4`mafla..- Mkt• • 'x'• y.. �y �I lis W., agc2w �In �• ��rrt}.�r i This -■x.�-�� '!'f�•-1!l.:.11�fllatiarfl..r'��l�+i.iii+�I..-..�i.m • .••.�•I!� j 6.�1n �!� 6■s ■r ■arl�YRs,i iw+i}! aP.e^r^..+..-.Tte• YT 1 nq. I� � •y. LI�1 Iyi,, _ �•s j/Ly�� y■5 ./I�� •i�r�[� �j ��,•I� �I..a}r-• - 4�ry 1.vi4Viil�:Ii-.�'4.-►.-r •r��1i17�•:•-•i ',a�l•-rf �Ir%Li a t a �a��it Is n�� valid until fa��tt�+� �� •V!. ��7 YYlra��Y■,1�7X� r�� t of 7��- r. __. .. ner t.' ar+a�aa aaxr. •�a ww + `_p t entt1ive the Department. COLORADO � ■,. ,ART MEIST OF TRANSPORTATION • �}•�•�+•■K �•••l_�.r.- it rr.a.1 I -, aY.$i alt. aaY• idMai a"aJ-.-_'•••..J yJr'•II•YYTTQ"!R :f ^f!* •x? - Pr.- Y .J lYfahf�r 1� {j fl at: +i_ . •• nyli4:v I P e S �14 3i '" Irr MAO 'I p - • f f•-�'. �i e- fTT•rni •i- • it itk irr'1''lI Dale 10 4 6j ^ 10 l.�lq.in.., �{,/�1y p rsM1 ,(.��Uforiat+tctJdltc1y a.•� :•i}�[�}� _m ��J■■/rL atati -a _sz tie%ra i1. �y l tj ��f1l rii• - •l.-t�•Ai'a a �M Pi ir4r i iri�i.•� � fr • C a lii! is tr•fl "_Y •oats iv -. i-•-r' r t a- r t'44ake Caps s aectzinst for, Previous uciltic 3.133aff Access Suitors Local &Arno* I,ua 4,C ntral Files IVITCE PiAjoi Thou eiveer tata utto a RequirS: l itc,ron Zptdcant • P a •.4 . — 4 r i I to Otter iotk y mat by u'iad i a3 COOT Fortin tilDi 5107 State Highway Access Permit Form 101, Page 2 4 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 perrnft was issued, the Issuing authority made its decision based In pad 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 isavailable, and safety and design standards. Changes in use or design not approved by the permit or the issuing authority may cause the mvocation or suspension of the permit. APPEALS 1. Should the permlttee or applicant object to the denial of a permtt 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 sight 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 shalt include reasons for the appeal and may include changes, revisions, or conditions that 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 appealprocedures of the local authority, 3. In submitting the request for administrative heating, the appellant has the option of including within the appeal ,a request for a review by the Oepartmenrs Internal admini five review committee pursuant to [Code] subsection 2.10. When such commtitee 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 adminlst'te 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 of 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 exten s ion from the Issuing authority. No more than two one-year extensions may be granted under any circumstances. If the ass is not under construction within three years from date of issue the permit will be considered expired. My request for an extension must be In writing and submitted, to the Issuing authority before the permit expires. The request should stale 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 wilting. The local issuing authority shah 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. My person wishing to reestablish an access permit that has expired may begin again with the application procedunas. approved Notice to Proceed, automatically renews the access pewit for the pUr od 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 perrniee except as provided in subsection 2.14. All materials used in the constru-ction of the access within the highway right-oiway or on permanent :easements., become public property. Any materials removed from the highway right*ot-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 Departrm--ent unless otherwise instructed by the permit or the Department inspector. 3. The perrriittee shall notify the individual or the office speed on the permit or Notice to Proceed at least two working days prior to any cc,rrgtion within state highway sight -of y. 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 uvithin 45 days from initiation of construction. within the highway right-of-way. . A construction time extension not to exceed 30 worming days may. be requested from the in dtViduai or office specified on the permit. 4. The issuing authority and the Department may inspect the access during construction and upon completion of the accessto 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 hall any activffies within state rightuofaway that do not comply with the provisions of the permit, thatconflict with concurrent highway construction ution or maintenance work, that endanger highway property, natural or cultural resources protected by law, or the health and safety of.workers or the public. S. 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 constriction 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 tight -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 cast 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 g, 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 fours, subbase, base course compaction, and materials specifications. Minor changes and additions may be ordered by the Department or local authority field fnspector 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 perrnittee or property owner shall contact the local issuing authority or the Department to determine If a new ass permit and modifications to the access are required, 2. When an access is constructed or used in violation of the Code, section 434447(5)(c), QRS., of the Act applies. The Department or issuing authority may summarily suspend an access permit and immediately order closure of the access when its continued use presents an Immediate threat to public health, welfare or safety. Summary suspension shall comply wirth article 4 of title 24, C.R.S, MAINTENANCE 1. The pennittae, 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 end replacement of any access -related culverts within the right-of-way. Within incorporated areas, drainage responsibilities far 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, Pale 3 COLORADO DEPARTMENT OF TRANSPORTATION Envfronmental Clearances Information Summa PURPOSE - This summary Ls Intended to in mi entities external to COOT that may be entering the state highway right-ofway to. perform work related la their own fac:Mii s (such as Utlr, Special Use or Aocess Perm a s), about some of the more comae* encountered �errvironrnerntal peni i t 'ctearan that may apply their act ties. Th:s listing not a nclusive additional environmental or cultural a�s�a a.� r� po�rr�ni �+'e;�a� n� may be required in certain �i instances. Appropriate local, state federal agencies should be contacted for addlllonal information if there is any uncertainty amt what permitsifolearances am required for a specific activity. IMPORTANT,— Please Review The Following inforrtm ation Carefully a Failure to Comply With Regulatory Requirements May Result In Suspension or Revocallen of Your COOT Permit, Or Enforcement Actions By Other Agencies CLEARANCE CONTACTS -As indicated In the permit ace descriptions listed below the following individuals or agencies may be contacted for additional information: ColoredD Department of Public Health and Environment (CCPHE)= General Information — (303)692-2035 Water Quality Control Division CCD)_ (303) 6924500 Environments! Permitiing Webslt hit s r'.•,+. SQradCl1;. vij, ctti :SIC: d�Aielai -'� °�'i`Illl� COOT Water Quality Program Manager (303) 75741343 till _/ . _t..c.oC r d �d t.7r f clre r_rr�___r .��rcrrmenta:livrat ri-guality CDOT Asbestos ProAact Manager. Theresa arttartge&s t ing p (303) 512-5524. Coiotado Otos of Archaeology and Histork Preservation: (303) 866-3385 US. Army Cps of Engineers, Distict Regulabory Offices: Omaha District (NE CO), Denver Office (303) 9794120 :Pd`i.rr''.9` . :),usace.armvorniLTIvilssia n sfRequlatoryProtic am/Ciaorad0.as x Sacramerd.o C (Western CO), Grand Juncton Office (9701) 243-1199 h t tryihwiwaspKrusatearmy,milifyiiaonsiRecrelatt�rw�us'1 Albuquerque District (SE CO), Pueblo Office (71.9)-543-94.69 hukari ie',suaus G, .ar y i niirl hissions'RegjUaroryPrograrnendP m not&Lawwx CDOT al Use and Ate- Perml�n,•. 303 7 Tg6 It �'Hww . t4I.; = dodo .l to'raisin oer`mits - ss� geological Resources Disturbance of wwtid�� shall fed rt`ra�rr��rrrr extent cable. Entry into areas of known or suspected threatened or mangers species habitat WU require special authorizaton from the COOT permtliing office. If any threatened or endangered sperm are encountered during the progress of Eh D permitted work, work to the subject area shall be halted end the COOT Regional Peualtffng Office and Region Planning and Environmental Manager shall bat contacted immediately, Aut horization must be provided by COT prior to the continuation of work ltdormation but threatened or endangered spades may be obtained from the COOT websitei htip !hi p'++vw.co'I+aradociotinfoloroetorrisio virorrtnenrtalLowlidife'ouldelinj§ or the Colorado Parks end Wildlife (CPti site, htin: l .c vv.sl;ate.co.us IearniP'ar5 0C -There menses r�dar�garedListbier, Additional guidance may be provided byt appropriate ReVon Planninand Environmental Manager EM, . l Resources Thee applicant mud _ u�� request a hie search of the perrnll area the Colorado Office of Arm try and Historic P'1 won ( HP), Denver, to ascertain If historic or archaeotogioal resources have previously been identified. Inventory of the permit area by a quailed cultural resourspecialist may be wry, per the recommendation of CDOT. If arthaoologioal stiesfartifscis or historic msources am known to exist p rfar to the initiation of the permitted work or are encountered as the project progresses, all work in the subs areashall be halted and the COOT Regional Perrnlitng Offtoe and Rogk n Planning and Environment Manager shall be contacted Immediately. Authorization must be pr ided by COOT prior to the'continuation of work. Additional! guidance may he provided by the Regional Perriliti'ng Office RPEIVI Contact In n: Contact the ON-IP for file searches at (303) 866-3395. Pal n+t to iJcal Re ounr - The applicant mast request a fossil «yfe search through the University of Colorado Museum Boulder, and the Denver Museum of Nature and Science to ascertain If paleantcrogIcai rescu: :s have been previously Identified. I en tory *Tithe permit any by a qualified d paleontologic may be necessary, per the recom rend ©tion of COOT. if fossils are 1 encountered during the permitted work? ail work In the subj shall be halted and theC' eT Regional Permitting Office and Region Planning and Environment] Manager shall be contacted Immediately. Authorization must be provided by COOT prior to the centtnuetion of work, Additional guidance may be provided by the Regional Pemiiltiing Office In the Permit Spo lad Provisions. Contact_Infomotion Contact the COOT Paleontologist at (303) 757 -gam Hazardous MatortakSoild Waste- The Solid Wastes Disposal Sites end Facilities Act CR.. 3040!-100, at el, and Regulations Pertaining to Solid Waste Disposal Sdes and Facilities (6 CR 1007-2), prohibit sclid waste disposal wftiwut an approved Celibate of Designation (a landfill perrnEt . The Colorado Hazardous Waste Act .MME 15-301 et aJ, and the Colorado Hazardous Waste Reg atio its (6 OCR 10 074} prohibit the transfer, btorage or disposal crap) of hazardous waste except at permitted l tD Stet There are no permitted landfills or TSD sites vefthin the Stale Highway Right of Way. Therefore, ail solid or hazardous wastes that might be generated by the activities of entitles entering the Stare Highway Right of Way must bo removed from the ROW and disposed P of at a permitted fealty or designated on point (e.g,,, for sold ter a uiffity or construction par y's own dump r). Ipresexisting Onoluding oil of petroleum' contemplated sit, asbestos, rinrrsls, mine Owings, Bonin waste or h��ardr materials contamination etc,.) is ercouniered during the performance ofworkpermitlee shall halt work In the affected area and immediately contact the COOT Regional Permitting Office for don eS to how to pis Contact moo: Andy Flurkey, CD DT Hazardous Materials Project Manager, (303): 5126'O. As.. g -- - trk on asbestos containing materials (ACM) must . besa e��lnlro �at�ria As ��tln +�11 Ail w with the apse requirements of the UPI* Air Pollution Control Division a (APCD) Regulation 8. Disposal of ACM, and work done In a8bestosoconlaminated soil, must comply with the COPHE liazardous Materials and'V'Waste Management Division's (HMWMD) Sold Waists Regulations. The application for any COOT' permit must opea c ally 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 LinLcPF.tjE_APCD and HMWMD Regulations can be ardcessed via the CUPHE Environmental Pemvatling Website sited above. Environmental Creareress Isom Summary age1 f 3 colors& Departrrtent of Tm rt ,or'taticrt Decanter J14 Additional information cgpcerntng c!rtarance pan CO T oi' la available frvm the COOT Asbestos Project Manager MOM 512- 5519„ or Theresa Sartain ctiDrellin' , P ' e rt Menaaement Su ! ervisor 303 _ 512-655244 7ransPcrtatlorr rai - No person may offer or accept a hazardous material for , transportation In commerce unless that hazardous authorized obtain authorization TegtstratIon003) person authorization is material by registered applicable and in must requirements, and a more Info be State 49* conformance properly call the OrtioradO with classed, or en HAZMAT Permit Federal Palle the exemption, Motor described, Utilities United from rtes paged, approval the Colorado Safety Carrier Commission: Department marked, or registration Public Administration, of Transportation labeled, has Utilities 303) 894,286.6. and in been issued. Commission. US DOT for condition Inter- regulations at 49 CFR, Part lit The for shipment as required or Vehicles requiring a placard, must Contest fnforrma : For and Infra -state HAZMAT Disc h of tired ed or Fill PAatwia!—+ Permits Administere-d Cv the U.S. Army Corps of'EnaI ears and Section 4nj "at tQual aer-tlfic. ioits batted ,bythe C[IPH - Corps of Engineers 404 permits are required for the discharge of line dredged nationwide would activities be or IF permits, required. materials (nwp 412). if which an into individual are Depending waters issued of 404 the for upon actives permit United the Is specific States, required, with relatively circumstances, including section minor 401 wetlands. lirnpacts. it water is bible q,uaiityrr There For that are example, certification various either there a types agenerar from. is the of a 404 nationwide or CDPHE permits, "individuar permit WOOD Including 404 Is for permit also utility I required. Contact the appropriate Corps District Reguletoni Office for Information about whet type of 404 permit may be required contact Information above . Cont the CDPHE Water Quail Control Division at 303 692-3500, Working on or in any $yearn •or is bank - In order to protect and preserve the state's fish and wikil ife resources from actions that may obtain solid 3) streams appti, tooliwi.m.colotadadoLinfot'rya segments obstrtiol, blue a Senate line having as of dimin on streams pear SCI wetlands USGS 40 guide h, toertifcaUon destroy; '.5' supporting fines present quadrangle agreed change, from within 25% upon modify, the maps; or 260 Colorado more yards by nmentaliwildlife,t COOT or andtor per upstream vary Department 2) and within a CPw, natural or intermittent 100 uideIines. downstream car existing yards of be Natural sums U p am accessed gill trea of Resources. providing the rn or or project at its downstream banks live A measured stream water ur tributaries, beneficial of is the by defined valley project; it to as may fish !englit andlor 1) be and represented new wince; 4) The segments CPW and/or to by a of Mta rmwater Con - , . ion P i SCP = rt ' n _o = = r Discha . a From Industrial Facilities a Discharges of stow ►rater runoff from CDPS We conancton Stogy : i' Gtos' 1 s Construction disturbing aci one Permilt. acre Contact ( or more e In - or scanstI certain egon; Ronneneral-its* types Contact of industrial the CDPHE facilities, Water such Quality a concrete Contml batch Division plants at (303) it. requires 592-3500. a COititinittion Dewaterinct hart or 1nfl. t-lonl - D ages of water encountered during excavation or work in wet areas may requires the SHE Construction WOOD at DemistingDischarge 3) 6924500. For Deviatering Permii. Contact Application Information: and Instructions, For ConstruirMon see Section Dewatering 3 at the CDPHE Dlechaige bite: remits, cord I - sattvpaw.ca or do v!i acific`crd{h t-censtructian-i, anemia sermitsF _ _ Al the rrl taste rate aaS_aWer ,. iw i a n it - D c h a rg from storm sevver systems s of larger ..S -1_W municipalitioe, by facility the CDPHE should and WQCC. contact from the the For municipally CDOT facilities highway that l regarding lie drainage. within storrY the system boundaries wntec related that lies of clearanctes a whirr municipality those that municipalities, that may is have subject been are to an established submit IVIS4 to permit, MS4 under the Pe that its owner Issued of such municipailtYs PAS4 permit. All discharges tope CDOT highway drainage system or within the Right of Way (ROW) must comply with the 000005 applicable .(hitio '/www,coio.riot,info/urocramsfe provisions of the Colorado Water C r ronrr*e Control ,l(wtraler- Act and uali the /documents/ma Colorado Discharge ft Permit ram -area Regulations -ma s and Permit CDR # COS -03000D - ,bI[ slim ec adios Dv/ acr'_ d het g -murk] a,ms4 p r ,4tt$). Discharges are subject to inspection by CDOT end CDHPE,, Contact �o to hit the sitwvAilicolorado. COPHE Water Quality eov :*Adri Conbol kd * Division heiw smunici at (30:3) al-ns4- 8924500 u ermits. for a listing of municipalities requIred to obtain MS4 Permits, or General Prohibition — lees - All discharges am subs to the provisions of the Colorado Water Quality► Control Act and the Colorado automotive h Lcz:lAmig', •', Discharge j.eeloradod.1doLlnfoibrograrnsterivi fluids, solvents, Permit alb Reg u or soaps ons. and Prohibited ennii sediment. erntai'iwater--CU discharges Allowable u afl%'-r°/cka include, nowstormwater ssia but . are i jjj . not Contact limited dishes infcnnation: to, substances can be found Contact such at as the wash Colorado water, paint, Deiartment of Public Health and Environment, Water Quality Control Di lion at 303 7-X3500. - -Unless GaneraleAtiewLization e Allowable a n or mwat a rr Dirtcha rats 1: (MIMS dons by COOT or the Waco as elgrificant sources of pollutants -to the waters of the State, the fuito 1ng discharges to stormwater systems are allowed without a Colorado Discharge Permit System permit: landscape irrigation, 'diverted stream fly, uncontaminated ground water infiltration to espande stern sewers, discharges from potable water sources, foundation drains, air c nditioning condensation, irrigation water, uncontaminated activities. Contact springs, info footing at drains; on: The water CDPHE line Water flushing, Dual' flows from Control riparian Division habitats telephone and #'s wetlands, listed and above flow . front firefighting l ro� Ion and S ilmant C�i trot PPracti - Furacti ides reequfring a Stormwater Consizuction Permit, erosion control requirements will taken hespecified In order through to minimize that erosion permit. P in and those sedimentation situations according where a to sternwater COOT permit Is Specifications not required, all 10725 reasonable and 208. measures All disturbances should P require a steblllzatlon plan, native seeding or landscape design plan. In any case, the CDOT Erosion Control and Stommaiter Quality Guide (most recent version) should be used to _ design erosion controls and to 'mature dasturbed vegetation. Contact In a ation: The bit CDOT :/ Navy w1_coloradodot-0iniot Erosion Control and ro Stonnwatcr rams/e. vironmentalaaririsca Quality Guide may be obtained ac-archilo..clureferosion-stern1 from the Bid Plans oat Office at ( '3) 757-9313 or from: Disposal of Drilling Flu :Drilling fluids used in operations such as Hodzontal Directional Drtiling may be classified as 'discharges or 'solid of 1llrtay, sewers, Waste f wastes'„ and roadside ulationsa disposed and ditches Small in of I.;imeral, at or c Should permitted any other uantilies facilities type of drilling be of pumped that mart fluid specifically -made solids ©r vacuumed or (lam soaps natural than from waterway t such cubic the construction wastes. is and prohibited of solids Disposal area, by may removed of Water drriil be left in g Quality fluids on from -site Control the Into altar State storm either armor Higihwny drains, being Solid stern Right Frnrimrur ental Ctearances Information Summary Page 2 of 3 Colorado Deparlsnent Transpotalion December 114 separated from fluids or alter Infiltration of the waled provided: 1) the drilling fluid consists of only water and bentonite clay. or, if - required for proper drilling properties, small quantifies of polymer additives that are approved for use In drinking water wen drilling; 2) the sorts are fully cowed in a pit, and are not likely to pose a nuisance to future work fn the area, 3) the solids am covered and the area restored as required by COOT permit requirements (Ublity, Special Use, or Access Permils, etc,). Contact Information: Contact CDP E (tiephone ors listed dove. 6 Noxious We _arid i_n sl e r F lan_mc ernent Plan Noxious Weeds end invasive Species ui 'an can be found contacting by the Cciorado Department of Agriculture (httPs iM v.t. iorado• ow/ acitic/aacoriservat!c1/noxiouswa d Colorado ©rfslon of Parks and Wildlife l�tt 'cpw..state_co.usfaboutusfp!saesJ'P.S -Nn44ousWeeds.aspx)+ in either case, management p I - - Q control trol of noxious weeds associated. ens. Ir�r�cl�rfr7 the - ----- with the � a�iv�l�r and �fta�anin� of equipment will be muilta�, concrete Washout Waste generated from concrete activities shy NOT be allowed to flow into the drainage ways,. inlets, receiving waters; or in the COOT ROW. Concrete waste shall be placed in a temporary concrete washout facility end must be located a minimum of 50 feet from state water. drainageways, and Inlets. Concrete washout shall only be perfon'ned as specified the CDOT Environmental Program and shall beIn acandance to CDOT specifications and guidelines. COMO Information: +f tact CDPHE or find additional information on the COOT website: ► ' ,.slim 01 A ) s 701 107. 294, 213 so' 620 Water Qy Ii r Control One or More Acrvs of Disturbance. �,p - ibe �n - - �a1I@ ReP_M p ds she contained and cleaned up as soon as bible. Spills Mal NOT be washed Into the storm drain or buried. All spills shall tlye reported to the CDOT Illicit Discharge Hotline at I1303)512 -444113(41-i20).„ as well as the Regional Permitting Office and Regional Maintenance Supervisor. Spills on highways, Into w'at a spill in the hi hwa exceeding 25 °airarrs�, or that may otherwise present an immediate dangerm�� ® �` i�t-�f wey public sell be reported by each ° 911, and sh al l also be reported to the COPIIHE at 1-877-518-5608, a��ai Tt l+ porgy Question err comments agent this rnfomiation mmary�rnay directed to Alex l ralei. COOT �. & Traffic En9 neerin friies Unit at (303) 751-98411 atex# rare statetcomus. Envlronnrental alaarances informailon Summary Paga o f 3 credo Department of Trensportatfon December '14 Department ct Tzartsponator tt is star e r r i1`•'.� C; j. y r k& r 1 [: t j 1 LV r ` Starmwatcr- runoff occurs when precipitation from rain or snovirmeli flows over the ground, Impervious surfaceslike roads and sidewalks prevent stormwater from naturally soaking into the ground 104 Storm ater can pick up debris, chentcais, dirt and other ,pollutants and flow into COOTis storm drain stem or directly into a stream river, lake, wetlarord or reservoir. Anything Oat enters Mars storm drain system is discharged untreated into the waterways we use for fishing swim ruing, and providing dr'inktng water, !y_ ti"• t7areledEret si,,.dari, !r�'1!rl it ;i •,r,,i M9 Gry:J*;:;qtr �• • I - l l ' r' f • rte • I I { �'�Fr 's1 j �� . • [] i'! 1 •-1 �r r 1 , r.I t + i �• c — fS iJ 1%.1tit, IT� �'. h Ms 101 t.IP}i ,. IIUl .e.a•.� I '' III 11,,'' I LI I ail LJ •-.I 'r'.l., r � 1;1��!r-f r NC4_'al r.•-•`5 Y<<. alI ',r i"' I ',DF r3 C l F- ( err is.111 • r +7ibri .Jtp:n;-• �'I .� t , �. ,' n , �, , Isa Tips for Reporting an Illicit Discharge Cali tha discharge hotline at ifatej 5224426 From a safe distance try to est;irrlate the amount of the dischan -. ?denti characteristics of the discharge (color, odor, l e. etc.,). Obtain Information on the vehicle dumping the waste till. applicable). Do not approach! call ocsP for illicit dumping. If possible, take a photo, record 0 license plate. For more information on CDOT Utility Permits: Ssnc c1 ?L y L" • For more information on COOT Access Permits: -ELI; zi.C:i vie?" °. m lant.mov busi ' - r itrr:•i tr}'. : ��G+�• _.,- i •rte_ For more information on CDOT Water Quality Program: *LOA AA "'1. I -'.r : 11• 'YM-P'�T¢.?. �luil.i`'e- -'•EY Ctrl l:111+ DerP4Pnr. � Jo TC:2 r-,+5r.S ze31.3 r • Lc • c 4— —. . - - 'Wan) a- V t •♦ q • I.ter a, 'Lc •••C. - Alt _ sit a r I r .,r .r c-•i .•4... N.y,, 1 . 1 Mr . .ti • ...a*...a*s Ir Y.! SI t C r • n • , L • „f r r CDOT h -a, 9uni .ipe 5.cp a Storm Sewer Sy.5:ern perrnf , atho. fr3se Sena r' @s (6.1541) from the Colorado fepartn ,t of' Ptrbill: Health r.:rd Envlrnrrrnent. The permluitates that only stormwa tar can be discharged from Cori 's s orrn Id t≤an l: stain Win k -�.•. t• nr. T'r`v tel'Qjttip - Waiter f- M, dral Tate LOCA . RfAILIM0DY As part of the permit, COOT has several different programs to prevent pollutants from entering Into the storm drain system: Construction Site Program New Development Redevelopment Program illicit Discharge Program Industrial Facilities Program • Public Ed u cation and Outreach Program Pollution Prevention and Good Housekeeping program wet Weather Monitoring Program cab I is re 'a p V at Department c. Txanspr station IN a a 14 t Y r , trtdhstrial fachIiflas can use control measures (CM) otherwise known a Best Management Practices IBM?) duringthe construction of a facilityand wtten operating The facility. Control measure are schedules of activities, maintenance procedures, and other management practices to prevent and reduce icon entering into COOT's on'n dry system. Control Measures also include treatment, operating procedures, and practices to control site run off which can Include structural and nan-structuraI control's. MUDS 11/4Q —P1 POLUSTAITD 511411O --- ROOM S. •a Q7*74 1 ORBS Pelf r Ernes retwoo eaten "-1- r t i to+ U "r CDQT defines a utility, or utility facility as any ,privately, publicly, or cooperatively owned liner facility, or system proctudng, transmitting or distributing the followings Communications i Cable television it Power lite Electricity Light Heat Gas / Oil 10 Crude Products I Water Stream 1 Waste Stormvator not connected with highway drainage Similar commodity d 'T• 9C' % . r 4 Y •. r 4 w 1 i• •J9 -V. ✓} 1 ,. i ``ZrTrilsl+r'' injman+f v R .etans a�ea"i � .>Ld" �a'y �.. '1ir.•e •. } J w • T -n ems. It • { • • •. r r, l•. r P Y .✓ f r • F ✓ ♦ 1 £-4 uC ri1r to rand o ua L n n,•',S.+� 4f t 1�7 , P�33.} '4': e4a {I t ....I of l a: M� V•. t,# .-4 or operators that hay; p et i4tin + ! to contribute athstticritilai poHu n t t water. �/�( Mani Report t and Induct: iin fo rmzt- on o' 1 discharge and water I; Wa1I` tY concerns. Provr d2 written rwir ; tS fxwiti1in 13&..oeatat disco's:2;7.i ;7.i to =PEE. Submit ian annual- r npori: to COPHir c nth riing the :umber of inforrnatkrnal brith'.r `s d? ittribute ; name and tithes of each individual trained, r T1 a ro are inflames when a utility Comp? mi, or other entity doing work in the state highway right -as way will require some type of environment& permit or clearance for that work, COOT ►w eut together an Environmental Clearances Information Surrtmztry for those applying for a DOT Utility and Sp cial Use Permit or Access Perto obtain all recruiriud dea ranceg. This fact sheet is given to each parrnittae and k avniZaii!e at: h a;::tDs.: MLitt . .o o t1'YT,�j.}wt aisientzjrc nnientmi resources Uidances stenclat /Enw roflrnentat%2QC?ea nccsc'j State Hi, way Access Permit 1 Attachment to Permit No. 416057 -• Additional Terms and Conditions I. If there are any questions regarding this permit, please contact Gloria Rice -Idler at (970) 350a-2148. 2. The Perrnittee shall refer to all additional standard requirements included with this permit and any enclosed additional terms, conditions, exhibits, and noted attachm€n. 3. Incorporated as part of tf.ds permit are the following: Application for Access Permit (CDOT Form No. 13 7) Permit (CDOT Form No. 101) and its two page attachment Exhibits: "A"- Access Plan "B"- Vicini.ty 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 Puttee. 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 c .mpated future conditions. 5. Access construction methods and materials shall conform to the Colorado Department of Transportation Standard Specifications for Road and Midge Construction (current edition), 6. If necessary, minor changes, corrections and/or additions to this pmt 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 theplans must be approved p in writing by the Department prior to commencement of any work on or within the State Highway ri i twft way. All workers within. the State Highway right-of-way shall comply with their ems-- lo..en's safety and health policies/procedures, and applicable US. Occupational Safety and Health Administration OSFIA. regulations latio including, but not limi.ted to the applicable sections of 29 CFR Part 1910 Occupational Safety and Health Standards and 29 CFR Part 1926 - Safety and Health Regulations for Construction. At a minimum, all workers in the State Highway rr t of -way, except when in their vehicles, shall wear the following personal protective equipment: Head protection that complies with the ANSI 8941-1997 standard; * At all construction sites or whenever there is a danger of injury to feet,protective footwear that complies with the ANSI 1-1999 standard will be worn; F * High visibility apparel as specified in the Traffic Control provisions of this permit (at a minimum, ANSVISEA 107-1999, Class 2).. Where any of the above -referenced ANSI standards have been revised, the most recent version of the standard shall apply. 7. This permit is subject to revocation due to: 1) Noncompliance with the provisions of this permit; 2) Abandonment; 3) Supersedure by new permit covering. the same installation; or 4) Co _ j act with necessary planned highway construction and/or improvements. The Permitte'e shall promptly ten m ate occupancy anc upon notice of cancellation of the permit from the Depaartmeat, unless a new permit is applied for and granted. State Highway Access Permit 2 Attachment to Permit No. 416057 - Additional Terms and Conditions 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 constniction 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 pmt by the Department and/or the issuing authority. 11. All other accesses to the property shall be removed immediately. Removal shall include, but not limited to, the return of the highway right-of-way side slopes, ditches, and fences to match existing adjacent conditions, INCLUDING OVAL OF ASPHALT APRONS. Any asphalt removed from the highway shall result in a smooth finished edge. 12. The Permittee is responsible for obtaining any necessary additional federal, std and/orCity/County permits or clearances . required for construction ct ion of the access. Approval of this access permit does not constitute verification of this action by the P ei nittee_ 13 All costs associated with the improvements to this access are the responsibility of the Permittee. This includes design, construction, signing and striping, utility relocation, testing of materials, and inspections. 14. No work will be allowed at night, or on Saturdays, Sundays, and legal holidays without prior authorization from the D a.r�ent. The Department may ay also restrict work within the State Highway right-of-way during adverse weather conditions. 15. Traffic detours or lane closures will not be allowed, unless pre -approved by the Department 16. Two-way traffic shall be maintained throughout the work area at all times unless specific fic written authorization is obtained from the Departement. 17. No construction vehicles shall be parked, or construction materials/equipment stored, on the State Highway right-of-way overnight. 18. 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 Permit Manager. The access permit does not authorize that activity. Irrigation of features within the right-of-way may require the perrnittee install subsurface drain in accordance with CDOT Standard M-605-1 or other approved system. The Permittee shall contact Gloria Him -Idler at (970) 350-2148, to obtain the Landscaping Permit. 19. Routine, periodic niaintenance and emergency repairs may be performed within the State Highway ri t- o fway, 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 State Higwa Access Permit Attachment to Permit No.416057 - Additional Terms and Conditions the movement or safety of traffic on the State Highway* In an emergency, the Department ent Re `on Office and the State Patrol shall immediately be notified of possible hazards. 20. All work is to conform to the plans referenced by this pmt on file with the Department or as modified by this peiuiit. (If discrepancies arise, this permit shall take precedence over the plans.) The Department plan review is only for the general conformance with the Department's design and code requirements. The Department is not responsible for the accuracy and adequacy of the design, dimensions, elevations,and any other elements which dual be coati nned and correlated at the work site. The Department through the approval of This document, assumes no responsibility for the completeness and/or accuracy of the plans. 21. e State requires a Certifi t of Insurance prior to commencing any work on the State Highway wa ri '- t- of--wa . Policies shall name the State of Colorado as additional Slimed party. ALIvendors, contractors,and utility companies shall procure, at their awn expense, andmaintain for duration of the work period, the following minimum insurance coverages: A. Standard workman's compensation and employer's liability, including occupational disease, covering all a nployr engaged in perfo of the work at the site, the amount required byState Statutes. B. Comprehensive general liability in the amount of $600,000 combined single limit bodily injury and property damage, each occurrence and $2,000,000 annual aggregate. C. Automobile liability in the amount of $600,000 combined single limit and property damage , for each accident. injury Certificates of insurance showing compliance with these provisions shall be attached to and made a part of this permit and be available on the site during construction. 22. All materials, equipment, installaton, construction, and design, ..including the auxiliary lane(s) and intersection improvements(s) within the State Highway shall be in accordance with the folloiwug Dep ent standard references as applicable. A. State Highway Access Code, 2 R601-1 B. Roadway Design Manual C. Materials Manual D. Construction Manual E. Standard Specifications for Road and Bridge Constriction, latest edition F. Standard Plans (M&S Standards) G. Manual on Uniform Traffic Control Devices (M.UtC.DP) for Streets and Highways and the Colorado Supplement thereto A Policy on Geometric Design of Highways and Streets, American Association of State Highway and Transportation Officials (AASHTO), latest edition I. ASSHTO Roadside Design Guide �'- Institute of Transportation Engineer's Trip Generation Manual, 6th edition Some of the reference treater als listed above (A through E) may be purchased from: Colorado Department of Transportation Bid Plans Room 4201 East Arkansas Avenue State Highway Access Permit 4 Attachment to Permit No. 416057 - Additional Terms and Conditions Denver, CO 80222-3400 (303) 757-9313 The State Highway Access Code may be purchased from: The Public Records Corporation 1666 Larayettee Street PO Box 18186 Denver, CO 80218 (303) 832-8262 The website address is: wwwrcod o►t ag y 23. Survey markers or monuments must be preserved in their original positions. Notify the Department at (970) 350-2173 immediately upon damage to or discover of any such _i' arkers or monuments at site. Any survey markers or monuments disturbed during the permitted work shall be repaired and/or replaced immediately at the expense of the Permittee. 24. Should any excavation encounter plant or animal fossils, the remains of historic or prehistoric structures, artists,(pottery, stone tools, arrowheac , etc) the work shall be andM---stopped the h'tt shall nod the Departinent inspector. 25. The Permittee or the contractor shall notify Bruce Barnett at (970) 350-2147 at least Miloworking d days - s prior to beginning improvements �' ing any access provcments or construction of any kind within the State Highway rig -iv -of. way. Failure to comply with this requirement may result in revocation of this permit 26. The Department inspector may suspend any work due to: 1) Noncompliance with the provisions of this permit; 2) Adverse .. p � weather or traffic conditions; 3) Consent highway construction or maintenance conflict with permit work; 4) Any condition deemed unsafe for workers or thegeneralpublic, The work . may be resumed upon notice from the Deptutinent inspector. 27. When it is necessary to remove any highway at -of -way fence, the posts on either side of the access entrance shall be steely braced with approved end posts and in confomunee with the Department's NI - 607 -1 standard, before the fence is cut. To prevent slacking g of the fence. MI posts and wire removed shall be rem to the Deparirnent. Contact Gloria like -idler at (970) .3.50-2148 to obtain the contact name of the correct personto return the materials to. 28. The access shall be constructed as per Exhibit "A". 29. Constmction traffic devices, when not in use, shall be removed or turned away from traffic. 30. The access shall be constructed perpendicular to the travel lanes of the State Highway for a minimum distance of 40 feet, and 041 slope down and away from the adjacent pavement edge at a rate : of 2% grade for a .rim of 20 feet. 31. The access shall be completed an expeditious andsafe ti anner and shall be finished within 45 days from initiation of construction within State Highway right-of-way. State way. Access Permit 5 Attachment to Permit No. 416057 - Additional Terms and Conditions 32. Any access gate shall be set back so that the longest vehicle using the access can completely clear the traveled way when the gate is closed. 33. All required access improvements shall be installed prior to the herein authorized use of this access. 34. The access shall be surfaced immediatley upon completion of earthwork construction and prior to use. 35. Surfacing of the access shall be completed as per Exhibit " A". 36. No paved surface shall be cut unless specified in this permit. Asphalt removal shall be saw cut to assure a straight edge for patching. 37. If frost, water or moisture is present in the subgrade, no surfacing materials shall be placed until all frost, water or moisture is gone or removed. 38. The P ermi ttee shall install a new 18 inch corrugated metal pipe and shall provide for proper side slopes. Culverst over 18 inces in diameter shall have end sections. i 39. The access shall be constructed and 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 righttof-way. Drainage to the State Highway right-of-way shall not exceed historical rate of flow. 4O+ The Permittee shall request final inspection by Bruce Barnett at (970) 350-2147 or within 10 days following completion of access construction, and prior to authorized use. The Permittee or their representative shall be present, 41, All existing drainage structures shall be extended, modified, or upgraded as necessary, to .accommodate all new constniction and safety standards, in accordance to the Department's standard specifications. 42. A fully executed complete copy of this permit must be on the job site with the contractor at all tines during constniction.. Failure to comply with this or any other constniction requirement may result in the immediate suspension of work by order of the Department inspector or the issuing authority. 43. The design and construction of :_ _c access improvements and/or development of this property shy not negatively impact adjacent nearby properties. Correction of the problem and cost resulting from damages shall be borne by the Permittee. 49. It is the responsibility of the Pcrmittec 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 Information a copy of e ��T �nr�cr��tal Clearance Summary" MIS) for details. The ECIS may be obtained COOT Permitting Offices or maybe accessed via the CDOT Planning/Construction-Environmental Guidance webpage at http://www.dot.state,co.uslenvironmental/Formslasp. FAILURE TO COMPLY WIM REGULATORY REQUIREMENTS MAY RESULT IN SUSPENSION OR REVOCATION Of YOUR CDOT PERMIT, OR ENFORCEMENT ACTIONS BY OTHER AGENCIES. State Highway Access Pemiit 6 Attachment to Permit No. 416057 - Additional Terms and Conditions ALL discharges are subject so s of the Colorado WaterQuality Act and the Colorado Discharge Permit to the � provisions Permit Regulations. Prohibited discharges include substance such as: wash water, paint, automotive fluids, solvents, oils or soaps. Unless otherwise identified by COOT 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 CDPI[E website at; thtu i t;I , aaco_usI'vM cP/Pe mils inittiw u 50. Utility plans are not reviewed or authorized by e Access Permit. They must be submitted to the legion Utility 0fti _ .the Pe ttec shall locate all utilities withinn the existing ri s t -of -way and any area which maybe effected by access or roadway improvements. Plans shall conform to Section 2.3(11)( of the State Highway Access Code, The Puttee shy contact the Region Utility Office at (970) 350-2164. COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS PERMIT APPLICATION Instructions: Please print or type issuing authority application acceptancodate: Contact the Colorado Department of Transportation (TOT) or your local government to determine our issuing a.i,rthor ty. Contact the issuing ou#ho►rily to Bete rmino what plans and other documents are required to be submitted with your application, Complete this bourn (somo questions may not apply to you) and attach all necessary documents and Submit It to the issuing author • Submit an application for each access affected, ` if you have any questions contact the Issuing authority, For additional inlorrnation sea DOT's Access Managoment tiwebsite at httP If erwwer ot.state.co. u siAccesse Perm h sandsx.tt it 1) Prop owner (Iketreit-tce) avei a Street reset ler- 03 City, s' it+ & zip (Cs- at) E -Mai afladdr ss 3) Address of pro 66,26�Q`"?0 oi s Caw_ to be served by permit (required) 2) Applicant or Agent for por,mittee (if different from properly owner) I .Mailing address City, stale p fPhoriO(requir&J E-mail address If available 4) Le -gal description of ro e : If withinjurisdictional4limit. P P i � of Municipality, calY undicr County, which one? kcal ota r:bcivutrdiAslcn 5) What State Hig fay are you requesting access from? in ?) How many feet is the proposed access from the nearest mile post? _ feet (LI N❑S aE❑W)from: mate date you intend to begin ccns.uuction 9kCheek here If you are requesting gin: new access Li temporary access (duration anticipated: LI change In access use O removal of access i i I 1Di smite ycil iownship i6) What side of the N y ❑ N S D E G W 1 T 4111N1 ic How many feet is the proposed access from the nearest cross street?621 feet(UN US U E N F from :PADItiter a 10) Provide existing proper tif use O improvement to existing access O relocation of an axisling access (provide detail) hud&cs_tCr/Ansi-ruck _ a ie Oond 11) Do you eve knowledge +�f any - - (e≤bd. q State access permits serving this property, or adjacent properties in which you have a P•ropertyInterest? no Li yes, if yes what are the permit number(s) and provide copies: endlor, permit date: 12) Ores the property avwnerown or have any interests in any adjacent property? no LI yes, if yes please describe; ITS) Are there other xlsting or dedicated public streets, roads, highways or access easements bordering Dr with ? O no yes, r r yes . list them on your plans and indicate the proposed and existing accesspoints.in the property? . 14) If you are requesting agricultural field access - how many acres will the access serve? a - 15) If you are requesting con m€,real or industrial access please Indicate the types and number of businesses and provide the floor area square foot businessil,and us$ square t' footage ale of each., g business square footage L 1 16) if you are requesting residential dovstopemont access, what is the type (single family, apartment, townhouse) and number of units? P_ number of units type number of units 17) Provide Iho following vehicle count estimates for vehicles that will use the access. Leaving the - -- _ - - - property pett,r then returning is two counts. j.. Indicate If your con rrts are �7 peak hour volumes or average daily volumes. ti br owe urtil veietr,In wen co a it or paasc g . cafe and n'gtrt ii R"d a$ rail Wu wines $ at farm vo4t c (card oeUp raei) LI n Multi un.1 aim al peak Dna seciturras Totei count of a fl vehir;es Previous editiana ate obsolete and may not be wed Page ` -- _ --- 1 of 2 CDOT Form #1 37 01/1 COLORADO DEPARTMENT OF TRAPISPORTAYI0P! STATE HGHWAV ACCESS PERffT APPUCATON - .. s — Tr , instructions: - Contact the Colorado Contact the issuing authority Department of Transportation to determine (COOT) or your local government to determine what documents be your issuing authority. plans and other are required to submitted with your application. Please Print Complete - Submit this fin an application (some for questions each may not apply access affected. to you) and attach all necessary documents and Submit it to the issuing authority or type If you have any questions contact the issuing authority. For achirtional information see CDOT's Access Management wabsite at httplitiva .�_da t.state,.ca.uslA° ssParmitsiindex.htm 110 Peeper- owner (Perrnittee) 2) Applicant or Agent for pemtit1ee g1dtfereril from prop rty ownerliverifl'idt ..... Simat I ad ass 7 Lie m.) -:? d I 1 ell Nktiling at dross 1,1 YI ari; Oily, Tole a zip Phone* .^ - City, state a zips ' rte #ii {r uired) •SO JffiA1&J21J_hOL?& �•r4�- 1�+-'� 6.�F _>.„�� _ _ _ Email ar dr. e E-mail address II available , , trt II,' I. . Levrilj 0 (.2 ( covv) 2) Address of pro to be served by permit (required) a, - 4) LegW mi.!? description .9r, .mar I Lae' of prperty: II sudFTIJn within jurisdictional lirntts Or of Municipality, 1 • city 651 f dd'or County. why il4^ztlN6F#+' _ _ on - Will ir, ....., .s _L 5) What Stale hligrorayr acre ¶fl9t you requesting amass from? B) What side of the ways? 7) How many feet Is the proposed amass from the nearest mite post? How many feet is the proposed access from the nearest cross street - feet {J N ■ S ■ E L1W) fro ru : Lej 10Z-1 feel {.0 N CI S 0 L, W) 15 ire m: i _) Lett' g ::::1�LA `'lit Lut k What is t id € approxirn.a.te 'F.1 0 dale you [intend to bogin construction? 9 Chief here if you jiit new ass Li change in access are requesting D temporary use a, access (duration anticipated: Lremoval of access ) 0 U lrxicrorrernent relocation to existing of an existing access access (provide detail) ll - - - 6 Y 16 - . - - r 10) Provide existing paro;pert use hi U 0 CCISCnSfrtd[1i, h-*rr Qy\d �-J ~e *�r � . u,_ . 1)4%1 ....._._z e t.L_ U f ,. 11) Do you awe knowledge of any State Highway s p it$ serving this property, or adjacent pr rtias in which you have a property Interest? no a yes if yes - what are the permit numbers) and provide copies: and/or, permit date: ._ ---. _ ..a__ 12) Does the property .9;‹ no owner CI yesi if own or have any interests In any adjacent yes - please describe: property? 13) Are there e other U no �� - tang yes, or dedicated if yes - list them public stream,, roads, on your plans and highways indicate or access easements the proposed and existing bordering or within access points. the property? ..n - 14)1f you are requesting agricultural field arms - how many acres will the access serve? u 1-) tkCes 15) i if you are requesting O,Mrnercial business/land use or industrial access please Iridicale squ are the types and number of business and provide the floor Icataye business area square footage of each, square loalage - -, i G) If you are requesting typo residential developernent access, what is number the type of (single units family, apartment, townhouse) typo, and number of units? a number of - - units ViCt Delf I I 11) Provide the following vehicle count estimates for vehicles that will use the access. Leaving the property then returning Is two counts. iz. I nfdi ie 0 of passenger cars and Fight (Tucks ii peak how vests a 04 mini WA tructis et putt haw Y s Upeak Ti your c hour volumes *unto are or _ aver daily volumes. -:rvz 0 oi shoe irk vet1 in excess aim ft a or leer t Old w a g Total count of all --.) vehicle _.Y - SIT .-s.. -...., - 1! -f . ,r• MIN- t -fit Si -n II_a r S tier f E .-Ira cif- rrrrir Previous editions am obsolete and may riot be used Page 1 of 2 CDOT Form #137 01110 CO 18) Check with the issuing authority to datermine which of the following documents are required to complete the review of our application. a) Properly map Indicating other access, bordaring roads and streets. b Highway driveway plan profile. o) Drainage plan showing impact trate highvvay right-of-way. 41 Map and letters wig utility Io Pions before end atter development In and along the right t -way, o) $ubdMsion, zoning, or development plan, Proposed access . g) Parcel and ownership reps including easements. h) Traffic studies, i) Proof of ownership. acionentmmamr - 1 a It is. the applicant's responsibility to contact propriate agencies and obtain allenvironmental � clearances that apply to their actly' + Such clearances may include Corps of Engineers 404 Permits or Colorado Discharge Permit System permits, or ecologically, archeological, historical or cultural resource a clearances, The DOT Environmental' Information Summary presents contact Information for agencies administering certain clearances, information about prohibited discharges, and may be obtained from Regional CST Utility/Special Use Permit offices or accessed via the COOT Plannin '+ en tnucti+ n-Environrl'lentats uldance webpage jiff t. ate: . iateln riro 2- All workers within the Slate 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, lrl�� lied the applicable sections of CFR Part 1910 Occupational riot - Safety and Health Standards and 29 CFR Part 1926 a Safety and Health Rogu.iattons for Construction. Personal protective equipment (e.g. head protection, footwear, high visibility apparel, safety 1 respirators, gloves, etc.) shall :appropriate ,' rOnes, hearing protection, p , _ ) be worn as appropriate for the work being pertom'ied, and as specified In regulation. At a minimum, all workers in the State Highway right of way, except when in their vehicles, Glee, shall wear the following personal protective equipment: High visibility apparel as specified In the Traffic Control provisions of the documentation accompanying the Notice to Proceed related to this permit (at a minimum, ANSWISEA 1074 99, class 2); head protection that complies with the ANSI Wig. i � 1 �' standard; and at construction - � p n all sites or whenever there is danger of injury to feet, workers shall comply with HA'S PPE requirements. for toot protection per CFR 1926.96, if required, such footwear shell meet the requirements 1910.136, �I�-��N and of ANSI Z41 Di999. Where any of the -referenced ANSI standards have been revised, the most recent version of the standard shall T The Perrnittee is responsible for complying with the Revised Guidelines that have n adoptedthe under the American Disabilities Act (ADA). These ul�dellnes define 'b`+� by Access Board �e+warss�xe slope :requirements and prescribe the use of a defined pattern of truncated domes as detectable warnings at street crossings. The new Standards Pla ns and can be found on the sign and Construction Project Support web page at: > then click on Des@n BUYS• if an access permit. Is issued to you, it will state The terms and conditions for its use, Any changes in permitted access not consistent with the terms and conditions listed on thepermit may the of the permit. be considered €trlolatit�n of the The applicant- declares under penally of perjury In the seed degree. and an ' other applicable la�wa� all information provided on form �'�� or federal true and thisand submitted attachments are to the best of their knowledge complete* I understand receipt 01 an access permit does not constitute permission to start access construction Applicant or Agent for Pormittee eignalure Print name Date If the applicant is not the owner of the property, we require this application also to be signed ned b the o their legally authoriz : �� representative (or other acceptable signature Nei' owner or application . written evidence), This signature shall �o with this ti7 II�VM ■ b��owners-of-interest � � � K Y�L1�� 'UR agreement y unless stated In writing. ii a permit is issued, the properly owner, In most cases, will be listed as the permtttee. Print name S1r1Q (riulkr Previous adios sro ctissalsto and may nal be used Paqo2 a12 COOT Form ink'' QUID A 'IT "A" _ MIME CDESIGN atm r ein e. width of access exclusive of radii radii profile angle if other than 90* surfacing -a material type (asphalt grading, concrete class, total thickneas, individual mat thickness for asphaltic materials) curb and gutter type/dimensions/material permanent signing or pavement madding necessary drainage features so culvert type and sins (no RCP in ROWI, Wit increased runoff to ROW special or unusual features any landscapingROW uiseCa.o n V - .a- M J ri �l ABC CtaLSO (t) _SS rir i vain � or 1 A r ci_J3u5IflaS3 r i 0)0 fl . ! . r" 3 Y fnr o' 111 ceni ,r 1 n . ; IA '• earth CESS PERMIT Pa\nt, Or 2. to SO iglu 13 ; Ellen A (5utrLke r,or -1 B 1 1 - _ 'r 7.1 tt- • it If •-1 is C4r; __-- Sr.t.L f f .• ._ r _, t• 101,1•—• �V _ I ) • C Fir 1 t; 1f drni...)poSed _MO QLtaEy qrc1ut/ • ;44 _ I r 0 1 1 I i I t I • I I 4 1 Pci!3c, z oe *);\ �;\ S 441 I Hello