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1st_ Ail
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 /C6()-/ C✓OL Phone 2,26 - 6r(/-(13.27
Address /6812 CR-1 City /,,,,v4,vro T- State c0 Zipy0roy
2. Address or Location of Access /688) 621 Lo ✓b.Ka.vr , CO .5'Oro y
Section 7 Township j Range 6 t Subdivision Block Lot
Weld County Road It: I Side of Road 4 Si Distance from nearest intersection
3. Is there an existing access(es) to the property? Yes X No #of Accesses j
4. Proposed Use:
❑ Permanent ❑ Residential/Agricultural ❑ Industrial
Temporary ❑ Subdivision ❑ Commercial ❑ Other
5. Site Sketch
Legend for Access Description:
AG = Agricultural
RES = Residential
O&G = Oil& Gas A C O
D.R. = Ditch Road
= House 11
o = Proposed Access a ��
• = Existing Access
I
NI « 3y
*###*++********************************
OFFICE USE ONLY:
Road ADT Dale Accidents Date
Road ADT Date Accidents Date
Drainage Requirement Culvert Size Length
Special Conditions
❑ Installation Authorized ❑ Information Insufficient
Reviewed By: Title:
-9-
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