Road Access Permit Form - 2013 printable pdf download

ROAD ACCESS PERMIT

WASHINGTON COUNTY ROADS

150 ASH AVE ● AKRON COLORADO ● 80720

Ph: 970.345.2701 Fax: 970.345.2702

Permit Number

RA________

WASHINGTON COUNTY

STATE OF COLORADO

Date_______________________________

Name of Applicant_______________________________________________________________

Email (optional)

(Name of owner if not applicant)

Address

City,

St,

Zip

Telephone number (s) _________________________________________________________

___

Phone(1)

Phone(2)

Fax

Is the applicant the property owner _________

or a contractor_______ Other _______________

Legal description as defined by the quarter/quarter section (Example: property located in SW1/4 of SW1/4 Section

2, Township 5 North Range 54 West)

¼ - ¼

Township________ Range________ Section _________

Section_______________________

Nearest intersection and distance from _________________________________________________

Reason for Application to access County Road: __________________________________________

________________________________________________________________________________

Drawing or Plans illustrating access (attach to application).

Are there currently any dwellings and/or structures upon the property for which this access permit

application is being made? _________yes ________no

Signature __________________________________________Date__________________________

Property owner

REVIEW BY ROAD SUPERVISOR PRIOR TO CONSIDERATION BY THE BOARD (If more space is

needed provide on the reverse side of this application)

1. Necessary improvements to be installed such as culverts, attach list:

2. Can access meet existing grade on County Road? ________ yes _______no

3. Any special conditions which will be required attach list or indicate none:

Road Supervisor Approval: ______________________________ Date _______________________

Approved By: _________________________________________ Date _______________________

Commissioner Chairman

THIS PERMIT ALLOWS ACCESS TO THE AFOREMENTIONED COUNTY ROAD

SUBJECT TO APPLICANT MEETING THE CONDITIONS, IF ANY, OF THE ROAD

SUPERVISOR AS SET FORTH WITHIN THIS PERMIT.

Fees: $30.00 for residential / agricultural purposes for graveled access roads

Additional fees may be imposed for Use by Special Review applications for

commercial, industrial uses

Make check payable to: Washington County

Approved: May 10, 2005 Resolution 103-2005

rev 2/13

RA RoadAccess.doc

Road Access Permit Form - 2013

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