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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 je, t *le ; fr, n4 4 �.. 1.,41:2.4"; C,. Phone i70 —•"fl5—far—7—Z 6
Address /6 7 c, pd -z q - City /&/ j-1 ,; rJl, State CO Zip 0-1/6.5-1
2. Address or Location of Access ✓0 wr e.-
Section q Township 3 4, Range &�[" tN Subdivision Block Lot
Weld County Road #: Z q Side of Road if-0 I Distance from nearest intersection 11 Goy 50{ c./2,
3. Is there an existing access(es) to the property? Yes X No # of Accesses 2
4. Proposed Use:
0 Permanent 0 Residential/Agricultural 0 Industrial
0 Temporary Subdivision > Commercial ; Other 0°y Kt h h L f
...............................................................................................................................
5. Site Sketch
Legend for Access Description:
AG = Agricultural
RES = Residential
O&G = Oil & Gas
D.R. = Ditch Road —
O = House
= Shed
A = Proposed Access
= Existing Access
-
NTH vi
.......................................
OFFICE USE ONLY:
Road ADT
Date Accidents Date
Road ADT Date Accidents Date
Drainage Requirement Culvert Size Length
Special Conditions
Installation Authorized - Information Insufficient
Reviewed By: Title:
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