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HomeMy WebLinkAboutC14-216 Land Use Authorization . i
STATE OF COLORADO
DIVISION OF MOTOR VEHICLES
Department of Revenue
DRIVER TESTING AND EDUCATION SECTION '1 .t r
Carol Olds,Manager
�3
BUSINESS LOCATION
1881 Pierce Street/Lakewood,Colorado
303-205-8412 John W.Hickenlooper
Governor
MAILING ADDRESS. Barbara J.Brohi
Denver,Colorado 80261-0016 Executive Director
Mike Dixon
Senior MV 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 Eagle County
Landowner(print)
is the property owner of the land located at:
3289 Cooley Mesa Rd Gypsum Colorado 81637
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.
Eagle County Jill Ryan grants permission to
Landowner(print) Landowner Representative(print)
Faglk C:nunty Schnnl District for the purposes of
CDL Testing Unit name
administerin: the CDL dri r g skills test and State inspections. GI 970-328-8605 �' '�
Lando r Representativ (signature) Phone# Date
This authorization expires on 7/1/2015 •
(Date Required)
CA