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HomeMy WebLinkAboutC12-227 Land Use Authorization STATE OF COLORADO k MOTOR CARRIER SERVICES DIVISION '' ; - ..; , CDL Compliance Section �` Department of Revenue i " ' - � �` I' 1881 Pierce Street, Room 114 � 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 ('/ (,© t 4 /f / / Landowner (pritft) is the property owner of the land located at: 32- 7f Co D /7y �e_r ?J y C W? 7 . Property address 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. I ' I - ‘,09/e , ' C06(4 grants permission to Landowner (print) / Landowner Representative (print) 4 / 67 C m 4ti (7Ic %66 / : 4' ( a/ for the purposes of / CDL Testing Unit name administer' C� /: • ' %• g skills test and State inspections. ( 11 - 0 5:)\ Rik; (p.to)--- Landowner Representative (s'_ ature) Phone # Date This authorization expires on �dr e° 36' 20 /3 . (Date Required)