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A9)E. i�4 ��� Est /lt``. ,; iwawe 99+ 2 6N jj} nil .4 li il it I R ', ' " $a f i itt; 1 16..le ; �F C 4 sCo III I I �o a.in 4 _ _ — _ _ _ A, NA p■ s arm .uxam air 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 ame L>` Phone .03 —93 I t Q3 Address ` 5 City ( BLS —,i State° zip_RO-S(� 2. Address or Location of Access 180 N u • 5 C D Q T 1141000 I p Section 5 TownshipI C Range _Subdivision rt3 { Y' Lott ay+k t Weld County Road#:otd CIL 5 Side of Road 50011 1-1 Distance from nearest intersection (g0ff r 3. Is there an existing access(es)to the property? Yes X No #of Accesses 4. Proposed Use: ❑ Permanent Residential/Agricultural 0 Industrial O Temporary ❑Subdivision 0 Commercial ❑Other 5. Site Sketch Legend for Access Description: AG = Agricultural RES = Residential L_ • O&G = Oil&Gas D.R. = Ditch Road 44 = House rMi = Proposed Access C. A P j07 + = Existing Access r 1,4�1 clI1Vi e F--�_ 14-I i OFFICE USE ONLY: Road_ ADT nate Accidents Date Road ADT Date Accidents Date Drainage Requirement Culvert Size Length Special Conditions 0 Installation Authorized ❑ Information Insufficient • Reviewed By: Title: -5- Hello