HomeMy WebLinkAboutC12-225 Land Use Authorization STATE OF COLORADO
MOTOR CARRIER SERVICES DIVISION
CDL Compliance Section _ _
Department of Revenue , u i,-_-,7,-
`
1881 Pierce Street, Room 114 °%
, a
Lakewood, Colorado 80214 -1497
Phone (303) 205 -5682 . John W. Hickenlooper
FAX (303) 205 -5981 Governor
,
Barbara J. Brohl
Executive Director
Kirstie Nixon
Division Director
LAND USE AUTHORIZATION
The land used for the purposes of driver skill testing not owned by the CDL Testing Unit shall require
written permission from the respective landlord or land owner on this form and submit to the CDL
Compliance Section for approval prior to driver skill testing.
This certification confirms that &a CO un / � �
Landowner (prifit)
is the property owner of the land located at:
32 �S at l y Aro pd 6t f co Y�C� 7 .
Property address / / 1
This property will be used for the purposes of CDL driver skill testing and access to the testing area
will be granted to the CDL Compliance Section for inspection at any time.
C (2 � grants permission to
Land (print) r Landowner Representative (print)
. CO (�ln_ri7 for the purposes of
CDL Testing Unit name
ir admi • — e .. - :r - ng skills test and State inspections.
Landowner Rep sentative (si: • ature) Phone # Date
This authorization expires on V; 30,.20(3 •
(Date Required)
