HomeMy WebLinkAboutState HWY Access PermitDocuSign Envelope ID: EADO1A20-ODEB-4067-B519-291DDCF39412
COLORADO DEPARTMENT OF TRANSPORTATION
STATE HIGHWAY ACCESS PERMIT
CDOT Permit No.
320091
State Highway No / Mp / Side
013A / 6.525 / Right
Permit Fee
$50.00
Date of Transmittal
07/28/2020
Region / Section / Patrol / Name Local Jurisdiction
3 / 06 / 6J36 Mike Bosshardt
Rifle
The Permittee(s): The Applicant(s):
Cruz Ricardo Holguin Villalobos
11749 County Rd. 320
Rifle, Colorado 81650
(970) 274-1047
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 Department 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: Located on the east side of Hwy 013 A approximately 4280 feet north of MP 6
Access to Provide Service to: (Land Use Code) (Size) (Units)
210 - Single -Family Detached Housing 1 DHV
Additional Information:
The access located approximately 900 feet south of this access shall be permanently closed.
MUNICIPALITY OR COUNTY APPROVAL
Required only when the appropriate local authority retains issuing authority.
Signature
Print Name
Date
Title
Upon the signing of this permit the permittee 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 David Raley 6J2 with the Colorado Department of Transportation, at (970) 629-2606 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
accept the permit and its terms and conditions
—lbeECajpe§lgnature:
PI
i'61
Print Name
cruz Ricardo Holguin villalobos
Date
7/29/2020 1 5:03 PM PDT
-Pprjff44g5Signature: (if applicable)
Print Name
Date
This permit is not valid until signed by a duly authorized representative of the Department.
COLORADO DEPARTMENT OF TRANSPORTATION
datigra by:
taitiLL GRUA
Print Name
Kandis Aggen
Title
Asst. Access Manager
Date (of issue)
7/30/2020 1 8:09 AM PDT
Required:
1.Region
2.Applicant
Make copies as necessary for:
3.Staff Access Section Local Authority Inspector
4.Central Files MICE Patrol Traffic Engineer
Previous edi ions are obsolete and may not be used
Page 1 of 3 CDOT Form #101 5107