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'.%;• l alp T` i • ' `,,` a 1nw 44k• tr. —\ te cn 5 - _. \ " 9 x< ti t ... ,.....:".:‘ 1 - ..=,-.71,41 . 1. 1.1411-.'--"04-'-'4 i•-4--- le • lilt Wit ' , , '" t �e • 7 "Ii.; • f , :" • "y• .r i s i It COUNTY ROAD NO. 7 � V� CO 4, Weld County Public Works Dept. 3 ! 1111HStreet ACCESS PERMIT ,ti ,„, i r h P.O.Box 758 Cs L Greeley,Co 80632 APPLICATION FORM 11,9/C*Cr- Phone: (970)304-6496 Fax:(970)304-6497 Applicant Property Owner(If different than Applicant) Name Name Company Highland Ditch Company Address Address 4309 SH 66 City State Zip City Longmont State CO Zip 80504 Phone Business Phone 970-381-6616 Fax Fax E-mail E-mail ♦=Existing Access A=Proposed Access Parcel Location&Sketch ]8 Mairt eve(CR y) The access is on WCR Nearest Intersection:WCR 7 &WCR Adams `iCR3Ti wcR Approx.112 mile south and east of intersection Distance from Intersection Parcel Number 120722000041 22-03-68 f Section/Township/Range T ix c :te_ LA Is there an existing access to the propertyioYES NO 0 N Number of Existing Accesses 2 Road Surface Type&Construction Information Asphalt rC Gravel n l Treated I I Other WCR Culvert Size&Type Materials used to construct Access Construction Start Date Finish Date Proposed Use ['Temporary(Tracking Pad Required)/$75 ['Single Residential/$75 ❑Industrial/$150 Fmall Commercial or Oil&Gas/$75 ❑Large Commercial/$150 ❑Subdivision/$150 ield(Agriculture Only)/Exempt Is this access associated with a Planning Process? ITINo USR nRE QPUD DOther Required Attached Documents -Traffic Control Plan -Certificate of Insurance -Access Pictures(From the Left, Right,&into the access) By accepting this permit,the undersigned Applicant,under penalty of perjury,verifies that they have received all pages of the permit application;they have read and understand all of the permit requirements and provisions set forth on all pages;that they have the authority to sign for and bind the Applicant,if the Applicant is a corporation or other entity;and that by virtue of their signature the Applicant is bound by and agrees to comply with all said permit requirements and provisions,all Weld County ordinances,and state laws regarding facilities construction. ib Signature Printed Name Date Approval or Denial will be issued in minimum of 5 days. Approved by Revised Date 6/29/10 WELD COUNTY ROAD ACCESS INFORMATION SHEET Weld County Department of Public Works • 111 H St PO Box 758 Greeley CO 80632 Phone: (970)356-4000 x3750 Fax: (970)304-6497 Road File#: Date: RE#: Other Case#: 1. Applicant Name t71-j-r L eenn. ,A Phone The- ZM- 5906 Address O gl} City / State Zip 2. Address or Location of Access '47* e-- 32_ Section 24. Township g Range Subdivision Block Lot Weld County Road#: Side of Road 54- Distance from nearest intersection yZ 14t‘ii 3. Is there an existing access(es)to the property? Yes X No #of Accesses 3 4. Proposed Use: X Permanents Recidasztiel/Agricultural 0 Industrial 0 Temporary 0 Subdivision 0 Commercial 0 Other pl(, ce,j ��-- ` Alfat C icr'4) 5. Site Sketch Legend for Access Description: AG = Agricultural RES = Residential O&G = Oil&Gas D.R. = Ditch Road = House 0 = Shed • A =Proposed Access ep = Existing Access aeaa1 � r fif#*#***fififi#fi#########*f*N#f#111NNfi OFFICE USE ONLY: Road ADT Date Accidents Date Road ADT Date Accidents Date Drainage Requirement Culvert Size Length Special Conditions 0 Installation Authorized 0 Information Insufficient Reviewed By: Title: • Hello