Form Center

2. Disclaimer

   Information submitted on this form will be sent via unsecured email. To protect sensitive information, do not enter the following items or similar information on this form: Social Security numbers, driver’s license numbers, bank account information, routing numbers, credit card numbers, medical information, passport numbers, and passwords. Please review our privacy policy located at www.jeffco.us/privacy. By submitting this form, you acknowledge and accept the terms listed in the privacy policy.

4. Information

   Jefferson County rarely grants vehicle and equipment access onto Open Space property without an existing recorded easement, license agreement, or for purposes that do not benefit Open Space. Each permit application will be evaluated based on the legal rights held by the applicant, purpose of work, and any potential impacts to the natural resources, normal park operations, and park visitors.

   Obtaining necessary utility locates is the responsibility of the applicant.

   Permission to cross private property, easements not held by JCOS, and County, State or Federal rights-of-way is the responsibility of the applicant. 

   Additional requirements may be necessary, depending on the type of work described in this application.

6. Applicant Contact Information
8. First Name*
9. Last Name*
11. Address*
13. Address Line 2
15. City*
16. State*
17. Zip Code*
19. Phone Number*
20. Email Address*
22. Business Name*
23. Your Title*
25. Contracted By; Include Company and Contact Name*
27. Phone Number*
28. Email Address*
30. Work start date and work end date:
    Work start date and work end date: Start Date

    Work start date and work end date: Start Time

    —

    Work start date and work end date: End Date

    Work start date and work end date: End Time
31. Type of work*

    1. Public utility work
    2. Private work
    3. Other. Explain

33. A non-refundable fee may be required based on your project's scope of work, no permit will be issued prior to payment. 

35. Do you possess an existing legal right to access this property, through a license agreement, recorded easement, or deed?*

    1. Yes. I have documentation verifying legal access.
    2. No.
36. Legal Access*

    Attach copy of license agreement, recorded easement or deed. 

38. Specific Location*

    Attach detailed legible site map(s) with route within the park, and work area. Plans shall have a North arrow, limits of proposed work with dimensions, proximity to roads and trails, ingress/egress, and structures. Plans shall also include areas of restoration. 

39. Insurance Requirement*

    Attach your Certificate of Insurance and must include Jefferson County as the certificate holder and meet any additional insurance requirements determined by Jefferson County Safety and Compliance. 

40. Scope of Work

    If you have a formal scope of work, upload here.

41. Reclamation Plan

    Attach your storm water, sediment and erosion control plan, and reclamation plan, if applicable. 

43. Additional Attachment
44. Additional Attachment
45. Additional Attachment
47. Summary description or scope of onsite activities including any excavation or grading work.*
49. Types and quantity of vehicles to be used onsite*
51. Types and quantity of equipment to be used onsite*
53. Safety Precaution Plan i.e signage, fencing, traffic control*
55. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
57. Electronic Signature*
Leave This Blank:


59. 1. Receive an email copy of this form.
60. Email address

    This field is not part of the form submission.

61. Submit

* indicates a required field