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N YI d F a F y� — QZ V J II aZJ . x + + + i � a zoo CC d she= J w w 0v_- e Q ~ = z Vf— ` — t- O ay az ,,,� c V O W E m u� O Iu a = 3 0x La V/ mot° = x Q (O I- ` W r W 0 M W U' 1 ass 1=- Q i it fW^ o = (O f- 1- x cX mak mjil a o Z cg a_ cn z x o a 1— I slip x tit Iii iii ... , ..._ ii, fi, a , .0 x iii fE X � if, ill IP III Sil Ill V 4a?.. .Aa{Wlp, • III X a0. t�xIII 'l≤; p �gi I pit a 4 WELD COUNTY ROAD ACCESS INFORMATION SHEET Weld County Department of Public Works III 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 Q� r� Phone `97 U- Address 'g4s4?� I Sr City cCID— Section , u 1.124_1 State Zip_aLa 2. Address or Lofiation of Access $44 3 Y b 14 Township z Range (p(p U) Subdivision f jukte Block Lot — Weld County Road#: )1 W1 Side of Road Nli 5f Distance from nearest intersection S&D ' 3. Is there an existing access(es) to the property? Yes X No #of Accesses l 4. Proposed Use: P-(,infiAL f IF i ❑ Permanent Residential/Agricultural ❑ Industrial CIII a * Temporary ❑ Subdivision ❑ Commercial ❑ Other ,ra 0/21-- // �0t ****************************************************************************************************************************** 5. Site Sketch Legend for Access Description: L.- AG = Agricultural RES = Residential O&G = Oil&Gas D.R. = Ditch Road O = House • = Proposed Access A = Existing Access N fi nbt�s A6. . is 1 I— S *************************************** OFFICE USE ONLY: Road ADT Date Accidents Date Road ADT Date Accidents Date Drainage Requirement Culvert Size Length Special Conditions O Installation Authorized ❑ Information Insufficient Reviewed By: Title: • 9 Hello