HomeMy WebLinkAbout1.09 Driveway permitRTZ INDUSTRIAL
P. O. BOX 1908
GLENWOOD SPRINGS, CO 81602
(970) 945 -5700
September 5, 2008
Garfield County Road & Bridge
Re: Permit Application
Attached is the Driveway Permit for County Road 300 and State Highway 6 and 24
If you have any questions, please contact us at (970) 945 -5700.
Very truly yours,
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Attachment
09/051206$ 10:50 979625BJ627 GARCG ROAD BRIDGE PAGE 01%04
Driveway Permit Check Off Form
1. Permit Owner: PT�Z I ndustriai
2. Address: PO BOX 19 o a
3. City: Carbundale 81623 ❑ Glenwood Springs 81601 xx
New Castle 81647 ❑ Silt 81652 ❑ Rifle 81650 ❑
Parachute 81635 ❑ Other
4. Phone No: 1 945-5700 Fax No: 1
S. County Rd. No: 300
6. dearest intersection or address: Cnty Road 300 and SH
7. Distance from bit or address : 11,100 Feet
S. Dircedon from Int. or address: N ❑ E ❑ S Q W ❑
9. Side of road: N ❑ E ❑ S ❑ W Xx
10. Width of driveway: 30 -foot ❑ 40 -foot L"J 100 -foot ❑
other;
11. Culvert rcgtiired: Yes xx No ❑
12. Size of culvert required, 12 -inch ❑ 15 -inch ❑ 18 -inch xx
Other:
13. Length of culvert required: 30 -foot ❑ 40 -foot ❑ othe 5 o f t
14. Asphalt or concrete pad required: Yes ❑ No ❑
15. Sin of pad: 34 -foot wide X 1 Mom long X 4 inches thick: Yes ❑
40 -foot wide X 10 -foot long X 4- inches thick: Yes xx
104 -foot wide X 20 -foot long X flinches thick: Ycs ❑
Other:
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09/05/2008 10:50 9795258627 GARGO ROAD BRIDGE PAGE 02/84
15. Gravel portion required: Yes ❑ Na xx
17, Length of gravel portion: 40 -foot ❑ so -foot ❑ 1 GO-foot ❑
18. Trees or brush removed for visibility, Yes Nv
19. Distance and direction from driveway to be removed:
20. Driveway must be no more than 3 % slope away from County road.
21. Drive must be constructed so no drainage accesses County road from driveway.
22. Certified traffic control required: Yes � No
23. Work zone sigua.ge -only required: Yes XX No ❑
24. Stop sign required at entrance to County Rd. Yes Fx_� No ❑
25. Inspection of driveway will required upon completion and must be approved
by person issuing permit or representative ofperson issuing permit.
26. Person Requesting Pemnmit: Thomas Zaacanella
27. Person issuing permit:
28. District permit issued in: 1 2 ❑ 3
29. Date checklist completed:
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69105!2009 18:50 9766258627 GARCC ROAD BRIDGE PAGE 53104
BOARD OF CpiTMY COM aSSIMMRS OF aWIBLD COMITY
CERTIFICATION AND AFFIDAVIT
REGARDING ILLEGAL ALIENS
The Contractor, whose name and signature appears below,
certifies and agrees as follows:
I. The Contractor shall comply with the provisions of
C.R.S. a- 17.5 -101 et seq. The Contractor shall not
knowingly employ or contract with an illegal alien
to perform work for the Board of County Commissioners of
Garfield County, Colorado ( "BOCC") or enter into a contract
with a subcontractor that knowingly employs or contracts
with an illegal alien.
2. The Contractor represents, warrants, and agrees that it
has verafi.ed that it Noes not employ any illegal aliens;
that it has participated or attempted to participate in--the
Bas;.c Pilot Employment Verification' Program administered by
the Social. Security Administration and Department of
Homeland Security; and otherwise shall comply with the
requirements of C.R.S. 8- 17.5- 1D�(2)!b1.
3 ...T'ne Contractor- shall comply with all reasonable requests.
made in the .course o$,an investxgaivrc under C.R.B..
1.02 by the Co�0rada Depq'rLmeni of Labor and Employment. If
the Contractor fails to comply with any requirement of. this
provi:si.o7n, or C.R, S . 5 -17.5 -101 et aeq. , the BOCC may
terminate work for breach and the Contractor shall be
liable for actual and consequential damages to the
State.
4. If the Contractor is a sole proprietor, the undersigned
hereby swears or affirms Under penalty of perjury under the
Taws of the State of Colorado that (check one):
I am a United States citizen, or
t/I am a Permanent Resident of the Un -ited States, or
71 am lawfully present in the United Status pursuant to
Federal law.
I understand that this sworn statement is required by
law because I am a sale proprietor entering Into a contract
to perform work for the BOCC. I understand that state law
requires me to provide proof that I am lawfully present in
the United States prior to staxting work for the BOCC. I
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