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WELD COUNTY ROAD ACCESS INFORMATION SHEET
Weld County Department of Public Works
O 111 H St PO Box 758 Greeley CO 80632
Phone: (970) 356-4O00 x3750 Fax: (970) 304-6497
Road File#: Date:
RE# : Other Case#:
1. Applicant Name 3 VAN 5n sit
Phone
Address City State Zip
T ` Cv,
2. Address or Location of Access J SC)...)--) ( Our.kot Il t\ 4 c,, JO,nk J igam xut
Section %-1 Township I Range 104k Subdivision Block Lot
Weld County Road #: U Side of Road S Distance from nearest intersection lit M l
3. Is there an existing access(es) to the property? Yes v No #of Accesses G
4. Proposed Use:
a Permanent 4" Residential/Agricultural ❑ Industrial
❑ Temporary ❑ Subdivision ❑ Commercial ❑ Other
***********************************************************************************************************************************
5. Site Sketch
Legend for Access Description: I
AG = Agricultural
RES = Residential
O&G = Oil &Gas
D.R. = Ditch Road
p 0 = House a `
Posed
osed Access
A = Existing Access
rs
IA.
NT
***************************************
OFFICE USE ONLY:
Road ADT Date Accidents Date
Road ADT Date Accidents Date
Drainage Requirement Culvert Size Length
Special Conditions
❑ Installation Authorized ❑ Information Insufficient
to Reviewed By: Title:
-9-
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